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.
PRINT OUT THIS APPLICATION AND MAIL WITH CHECK
TEAM: (Min 3 Top three score) All must come in same envelope
TEAM NAME: ___________________________________ -----------------------------------------------------------------------
LAST NAME: _____________________________ FIRST NAME: ________________________
SEX: ____________ DOB: ____________ AGE ON RACE DAY: __________
ADDRESS:___________________________________________________
CITY: _________________________________ STATE: ________ ZIP: _________
TELEPHONE: ___________________________ EMAIL: _____________________________
T SHIRT: S M L XL
SIGNATURE: ____________________________________________
(parent or guardian must sign if under 18)
Entry Fees: 5K RUN $17.00 By AUG 21 - $20 After and on race day
$10 special pre reg fee for high school team mates!
70 and Over Free!
Make check payable and mail with application to:
MADD DASH
565 Washington Ave
North Haven, CT 06473
Questions? msrunningproductions@yahoo.com