MAXWELL'S SHAMROCK 5K ROAD RACE

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 and claims for damages I may have against,  the race director and officials, Max's Grill, , The Stratfordt Police Department, the Town of Stratford, MS Running Productions, HI-TEK Racing, their representatives, any and all race sponsors and supporters, volunteers, their agents, successors and assigns, for any and all injuries suffered by me in said event. I assume all risks with entering this event, including but not limited to falls, contact with other participants, effects of weather, including high heat and humidity, extreme cold or wind, traffic and the condition of the road. All such risks being known and appreciated by me. I attest and verify that I am physically fit and sufficiently trained for the completion of this event. Further, I hereby grant full permission to any and all the foregoing to use my photographs, videotapes, motion pictures, recordings, or any other record of this event for any legitimate purposes without compensation or remuneration. I know that bicycles, in-line skates and skateboards are not allowed on the course.


PRINT OUT THIS APPLICATION AND MAIL WITH CHECK


 NAME:	________________________________________ FIRST NAME: ___________________________

ADDRESS:___________________________________________________

CITY: 	_________________________________ STATE: ________ ZIP: _________

SEX:	______ 	DOB ____________ AGE ON RACE DAY: _______________ T SHIRT:   ADULT:  XS    S   M   L   XL
TELEPHONE: ___________________________                 EMAIL: _________________________________________
                                          Please print your email so we can contact you with updates or emergency changes.

SIGNATURE: ____________________________________________ (parent or guardian must sign if under 18)
Entry Fees
Until Feb 2 - $25 ages 21 & Over $18 ages 20 & Under
Feb 3 - March 22 $30 / $18
March 23 - NO REG
March 24 - At Reg/Shirt PIckup $35 / $20 at Maxwell's Grill from noon - 5pm
March 25 - Race Day $25 / $30

Make Check Payable and Mail To:
MSRP
245 Laurel Street
Stratford, CT 06615

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