Bookin' it on the Monon    Saturday, October 2, 2004
Web Entry Form 

rRun rWalk rOne Mile Family Walk
Name:___________________________________  Age on 10-2-04:______ rMale rFemale
Street:_______________________________________________________________________
City:________________________________________State:_____________ Zip:___________
Day Phone:_________________________ Evening Phone:___________________________
E-Mail ________________:____________________________
T-Shirt size:  rS    rM     rL     rXL     r XXL

Fees:  Pre-registered on or before September 25 - $15.00
After September 25 and race day - $18.00

CHECKS ARE PAYABLE TO:  Tuxedo Brothers

MAIL COMPLETED ENTRY FORM AND PAYMENT TO
Tuxedo Brothers, 6265 Boone Ridge, Zionsville, IN 46077

Waiver (must be signed)
In consideration of the foregoing, I for myself, my heirs executors and administrators, waive and release any and all rights and claims for damages I may have against any of the sponsors, organizers, City of Carmel, Carmel Clay Public Library (including its staff members and volunteers),  Carmel Clay Parks and Recreation (including its staff members and volunteers), St. Vincent Hospitals, Tuxedo Brothers, Inc., for any and all claims of damages, demands or less actions whatsoever which may arise as a result of my participation in this event.  I understand and acknowledge that participating in this walk/run event may expose me to dangers from both known and anticipated risks.  I attest and verify that I am physically fit and have sufficiently trained for the completion of this event and my physical condition has been verified by a licensed medical doctor.  Further, I grant full permission to any and all of the foregoing to use my likeness for any legitimate purpose whatsoever.

______________________________________________________        _______________
Signature of Entrant                                                                                         Date
(Signature of parent/guardian if entrant is under 18 years old.)
Incomplete/unsigned entries will not be accepted. - Entry form can be copied.
Deadline for mailing is September 27, 2004