Race to the New Year!    Saturday, December 29, 2007
Web Entry Form 

Name:___________________________________  Age on 12-29-07:______ rMale rFemale
Street:________________________________________________   Date of Birth ___________
City:________________________________________State:_____________ Zip:___________
Day Phone:_________________________ Evening Phone:________________________
T-Shirt size:  rS    rM     rL     rXL    rXXL
Fees:  Pre-registered on or before December 20 - $15.00
After December 20 and race day - $20.00
Credit Card - Master Card/ VISA / Am Exp (circle one)
Card # _____________________________________________ Exp Date ____________
Total amount to be charged: $_______   Signature below authorizes credit card

CHECKS ARE PAYABLE TO: Washington Township Parks

MAIL COMPLETED ENTRY FORM AND PAYMENT TO:                                                      CODE 8202.301
Washington Township Parks and Recreation
1549 E. Greyhound Pass
Carmel, IN 46032

WAIVER/RELEASE:
I have read the accompanying event information and understand the policies of the event. I know that running and walking a road race is a potentially hazardous activity. I should not enter unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run or walk. I also know that while police protection will be provided, there may be traffic on the course. I assume that all stakes associated with my voluntary participation in this event, including but not limited to falls, contact with other participants, the effects of the weather, including extreme temperatures, snow, ice, traffic and all conditions of the road, all such risks being known and appreciated by me. Knowing these facts and in consideration of your accepting my entry, I for myself, my heirs, executors, administrators or anyone else who might claim on my behalf, covenant not to sue and WAIVE, RELEASE AND DISCHARGE Washington Township Parks and Recreation, City of Westfield, Hamilton County Parks Dept., Tuxedo Brothers, Inc.,, race officials, workers or volunteers, their representatives, successors or assigns for ANY AND ALL claims of liability, whether foreseen or unforeseen for death, personal injury or property damage ensuring out of or in the course of my participation in this event. I agree to use the Champion Chip timing device and return it upon completion of the event. If I fail to return this Chip, I will pay the $30 replacement cost. I further give full permission to the above-mentioned sponsor(s), organizers, and/or agents authorized by them, to use any photographs, videotapes, motion pictures, recording or other record of the event for any reasonable purposes.
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 22, 2007