PRINT OUT THIS APPLICATION AND MAIL WITH CHECK
WARREN STREET ST. PATRICK’S DAY CLASSIC
4M ROAD RACE & 2MILE FITNESS WALK & 1 MILE YOUTH RACE & FAMILY FUN RUN &
1/2 MILE KIDS FUN RUN
SUNDAY, MARCH 16, 2008
Mail Entries (with check payable to "St. Patrick’s Day Classic") to:
Warren Street St. Patrick's Day Classic
C/O Joe Riccio
13
Valley Court, Branford, CT 06405
PLEASE PRINT CLEARLY: Circle Event Entered
| 4 Mile Race | 2M Fitness Walk | 1 Mile Youth Race | 1/2 Mile Kids Fun Run | |
| Through March 15th | $17.00 | $10.00 | $8.00 | $6.00 |
| Race day | $25.00 | $12.00 | $10.00 | $8.00 |
LAST NAME: _____________________________________ FIRST NAME: _________________ DATE OF BIRTH: _______________
ADDRESS: ______________________________________________ CITY/TOWN: __________________ AGE RACE DAY: _______
STATE: _____ ZIP CODE: _____________ PHONE: (_____) __________________ SEX (M or F): ______ T-SHIRT SIZE: S M L XL - Youth Size S M L XL
EMAIL: ____________________________________________________
WAVIER: In consideration of accepting this entry, I the undersigned, intending to be legally bound, for myself, my heirs, executors, and administrators waive and release the Warren Street Social and Athletic Club of Connecticut, Sponsors, Volunteers, the Town of Fairfield, the Fairfield Police Department and their agents, employees and representatives from my participation in this event, including any and all injuries, incurred by me because of my participation in this event. I am physically fit and have trained sufficiently to complete this event. Applications for minor, under the age 18, will be accepted with a parents signature.
Signature of Athlete (Parent’s Signature if under 18)
_________________________________________________________ Date: ________________________________
MAIL TO:
WARREN STREET ST. PATRICK’S DAY CLASSIC
C/O Joe Riccio
13 Valley Court, Branford, CT 06405