Jingle Bell Run/Walk    Saturday, December 8, 2007
Web Entry Form 

rRun rRacewalk rFitnesswalk   rSanta Weight (160 lbs females / 200 lbs males)
Name:___________________________________  Age on 12-8-07:______ rMale rFemale
Street:_______________________________________________________________________
City:________________________________________State:_____________ Zip:___________
Day Phone:_________________________ Evening Phone:___________________________
Team Name:________________________________________________________________
Captain:____________________________________________________________________
Employer/School/Organization:___________________________________________________
T-Shirt size:  rS    rM     rL     rXL     r XXL
r Check here if you have ARTHRITIS - Type_______________________
Fees:  Pre-registered on or before December 1 - $20.00     (Children 12 and under- $10)
After December 1 and race day - $25.00         (Children 12 and under- $15)|
Team Division - $25 per teammate  - no race day registration for teams.

CHECKS ARE PAYABLE TO:  Arthritis Foundation, Indiana Chapter

MAIL COMPLETED ENTRY FORM AND PAYMENT TO: 
Arthritis Foundation's Jingle Bell Run/Walk
615 N. Alabama Street - Suite 430
Indianapolis, IN   46204

WAIVER/RELEASE:
I hereby certify the following: (1) I am physically fit and have received medical clearance to participate in the Jingle Bell Run, (2) In consideration for my application to participate in the Jingle Bell Run being accepted, I, on behalf of myself, my heirs, and assigns, and my estate, hereby waive and forever discharge the sponsors, organizers, affiliates, as well as their agents and employees from any and all claims that may accrue as the result of my participation.
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.
Deadline for mailing is December 3, 2007.