Run for the Bone - September 24, 2006
Web Entry Form
r 4 Mile Run r 4 Mile Racewalk  q 4 Mile Fitness Walk
Name:___________________________________  Age on 9-24-06:______r Male r Female
Street:_______________________________________________________________________
City:________________________________________State:_____________ Zip:___________
Day Phone:_________________________ Evening Phone:___________________________

Long Sleeve T-Shirt size:  r S r M r L r  XL r  XXL
Fees:
Pre-registered on or before September 21 - $20.00
After September 21 and raceday - $23.00
CHECKS ARE PAYABLE TO:  Stacy McKay Foundation

Mail completed entry form and entry fee to: 
Run 4 the Bone, 8648 Bay Colony, Indianapolis, IN 46234

RACE PARTICIPATION AGREEMENT:
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 Indianapolis, Department of Parks and Recreation, Stacy McKay Foundation,
Tuxedo Brothers, Inc., for any and all claims of damages, demands or loss actions whatsoever which may arise as a
result of my participation in this event. I understand and acknowledge that participating in this inline 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_______________________________________________ Date __________________
Parent’s or Guardian’s Signature if under age 18__________________________________________ Date ______________
Incomplete/unsigned entries will not be accepted. - Entry form can be copied.