Circle City Sprint -   Sunday, October 2, 2005
Web Entry Form (must be postmarked by Monday, September 26, 2005
Which event are you entering (see info page for more info) ______________________________________
Name:___________________________________  Age on Race Day:______ rMale rFemale
Street:_______________________________________________________________________
City:________________________________________State:_____________ Zip:___________
Day Phone:_________________________ Evening Phone:___________________________

T-Shirt size: rS  rM rL rXL rXXL

CHECKS ARE PAYABLE TO:  RHI Sports Program
MAIL COMPLETED ENTRY FORM AND PAYMENT TO: 
Circle City Sprint, 4002 Lakeside Dr., Muncie, IN 47304

RELEASE AND WAIVER STATEMENT (Must be signed) I have read the Circle City Sprint  entry form completely and understand the policies of the event.  I know that participating in this run/walk event is potentially dangerous.  I should not participate unless I am medically able.  I understand the nature of, and assume all risks associated with my voluntary participating in this event, including, but not limited to falls, contact with other participants, the effects of weather, including extreme temperatures and precipitation, and traffic.  Knowing these facts, I for myself, heirs, executors, administrators or anyone else who might claim on my behalf, covenant not to sue and WAIVE, RELEASE AND DISCHARGE Major Mobility Productws, the Rehabilitation Hospital of Indiana Sports Program, the Circle City Sprint Race, the Rehabilitation Hospital of Indiana, Marion County and its government, the City of Indianapolis and any an all sponsors affiliated with the 2005 Circle city Sprint, Tuxedo Brothers, Inc, race officials, workers or volunteers, their representatives, successors or assigns for ANY AND ALL claims or liability, whether seen or unforeseen, for death, personal injury or property damage arising out of, or in the course of, my participation in this event.  I further grant full permission to the Circle City Sprint and/or agents authorized by them to use any photographs, video tapes, or other record of the event for any reasonable purpose

Signature_______________________________________________ Date __________________
Parent’s or Guardian’s Signature if under age 18________________________________ Date ______________
Incomplete/unsigned entries will not be accepted. - Entry form can be copied.