MADD DASH 5K

Please understand that this event is rain or shine & non-refundable. Remember this event & its proceeds are for charity. You can send more by separate check for MADD. We thank you in advance for your help. I hereby release the Fairfield County MADD, the Town of Stratford, MS Running Productions, LLC, HI-TEK Racing, LLC, all personnel involved, volunteers, and co-sponsoring company(ies) from responsibility, from any injuries or damages I may suffer as a result of my participation in the MADD Dash. I hereby certify that I am in good condition and am abler to safely compete in this event. I will additionally permit the use of my name and pictures in print and broadcast, etc. As a participating athlete I certify that the information provided by me in this form is true and complete. I have read the entry information provided for this event and certify my compliance by my signature below.
Please remember it is illegal to give or transfer a bib to anyone else. Doing so will disqualify both people and void any & all claims against the event & its personnel


PRINT OUT THIS APPLICATION AND MAIL WITH CHECK

CHOOSE ONE:   5K RUN/WALK     _____                           2 MILE LIGHTHOUSE STROLL _______

LAST NAME: _____________________________ FIRST NAME: ________________________

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

EMAIL:___________________________________________________
Please print email so we are able to contact you with updates, emergency details & Results)
ADDRESS:___________________________________________________ CITY: _________________________________ STATE: ________ ZIP: _________ TELEPHONE: ___________________________ EMAIL: _____________________________
You must include email so we can reach you with any changes or cancellations.

T SHIRT: S M L XL SIGNATURE: ____________________________________________ (parent or guardian must sign if under 18)
Entry Fees: EARLY REGISTRATION MUST BE RECEIVED BY MAY 31st $23 - $27 Regular reg must be received by Aug 2 -  $30 After and on race day
                  $15 special reg fee for all participants 18 and under For Entire Pre-Reg & Race Day
	  
Make check payable and mail with application to:

MADD CONNECTICUT
C/O MS Running Productions 
245 Laurel St
Stratford CT 06615
Questions? msrunningproductions@yahoo.com

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