NYC MARATHON BUS
Sunday November 5

I hereby release Bob Sabre, Beachside Estates, the Stratford Hotel, The Runners Roost, the Land Jet bus company, all personnel involved, volunteers, from responsibility, from any injuries or damages I may suffer or my vehicle as a result of my participation in the NYCM Bus Trip. I hereby certify that I am in good condition & am able to safely compete in this event. I will additionally permit the use of my name & pictures in print & broadcast, etc. As a participating athlete & bus passenger  I certify that the information provided by me in this form is true & complete. I have read the entry information provided for the event & certify my compliance by my signature below. I promise not to complain about the traffic or anything else for that matter. I will have a good time & say thanks to the Bob & volunteers.  It will really mess up our insurance so please no baby strollers or dogs !! (unless Bob says it is OK)

PRINT AND MAIL WITH CHECK


RETURNING ON BUS? YES_____ NO _____ MAYBE _____
NAME: ______________________________________________________ SEX: ____________ DOB: ____________ AGE ON RACE DAY: __________ ADDRESS:___________________________________________________ CITY: _________________________________ STATE: ________ ZIP: _________ TELEPHONE: ___________________________ EMAIL: Important for updates: _____________________________ CELL #_____________________________ ALT # __________________________ EMERGENCY #________________________________ Approx Finish Time: _________________ EMERGENCY CONTACT: _____________________________ RELATIONSHIP: _______________ SIGNATURE: ____________________________________________ (parent or guardian must sign if under 18)
$62.00 By September 15 - $74 AFter Make check payable and mail with application to:
Bob Sabre
198 Fairfield Beach Road
Fairfield CT 06824

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