27th Annual
Bigelow Tea Community Challenge
Sunday September 28, 2014

In consideration of acceptance of this entry, I the undersigned, intending to be legally bound, do hereby, for myself, my heirs, executors and administrators, waive and release any and all rights for claims for damage I may have against RC Bigelow, Inc. or any and all race sponsors, or the cities and towns in which this race is contested, their representatives, successor or assign for any and all injuries suffered by me in said event. I attest and verify that I am physically fit and sufficiently trained for the completion of this event and my physical condition has been verified by a Licensed Medical Doctor within the last six months. Further, I hereby grant full permission to any and all of the foregoing to use my photographs, videotapes, motion pictures, recordings or any other record of this event for any purpose whatever, without compensation or remuneration.


PRINT OUT THIS APPLICATION AND MAIL WITH CHECK



EVENT CIRCLE ONE:   5K ROAD RACE              2 MILE FITNESS WALK       KIDS FUN RUNS   
NAME:	______________________________________________________

SEX:	____________ 	DOB: ____________ AGE ON RACE DAY: __________

ADDRESS:___________________________________________________

CITY: 	_________________________________ STATE: ________ ZIP: _________

TELEPHONE: ___________________________ EMAIL: _____________________________

T SHIRT:  ADULT:  S   M   L   XL    YOUTH:  S   M    L


SIGNATURE: ____________________________________________
           (parent or guardian must sign if under 18)


Entry Fees: 5K RUN: $20.00 By SEP 19th -  $25 After and on race day
	    2 MILE WALK: $15 By SEP 19th - $20 After and on race day
            KIDS FUN RUNS: $10

Make check payable and mail with application to:
Bigelow Tea Community Challenge
C/O HI-TEK Racing
7365 Main Street, #183
Stratford, CT 06614
203-337-6132

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