Please make checks payable and mail entry form to to: RacePacket, Inc, PO BOX 25094, Arlington, VA, 22202. Late fee is for entries postmarked after August 1. Incomplete or illegible forms of forms without the correct fees will be returned

         Name: 

      Address: 

         City: 

        State:    Zip: 

        Phone: 

       E-Mail: 

Date of Birth:    Age on race date(8/6/06): 

       Gender: M F        Event: 5K 

   Shirt Size:  M L XL

    Entry Fee: $18 until 7/31/06 $20 for forms postmarked after 7/31/06

In consideration of my application, I hereby, for myself, my heirs and executors, waive release and forever discharge any and all rights and claims for damages which I may have or may hereafter accrue to me against the organizers and sponsors of the Summer Stridews 5K, RacePacket, Inc, WRC, Pacers,  and all race sponsors and their representatives, successors and assigns, for any and all injuries suffered by me in said event. I attest and verify that I am physically fit and have sufficiently trained for the competition of this race, and my physical condition has been verified by a licensed medical doctor. Further, I hereby grant full permission to any and all of the foregoing to use my name, photographs, videotapes, motion pictures, recordings or any other record of this event for any legitimate purpose without compensation or reenumeration.

_______________________________  _____________ _____________________________________

Signature                        Date          Parent's Signature if under 18