Georgetown Classic 10K Entry Form

Registration Form for the 22nd Annual Georgetown Classic 10K
Sunday, October 7, 2001 - 9:30 AM

Make check payable to: Georgetown Classic 10K
Mail to: Georgetown Classic 10K, 13710 Ashby Road, Rockville, MD 20853-2903
Fax credit card entries to: (301) 871-0006 until October 4 Don't mail after September 30

Today's Date:   , 2001
Entry Fee: $22   $25 after Sep. 16 $25 on raceday
I want to volunteer   Wheelchair                                                                                                  Register online and save $2
I am a ChampionChip owner and am deducting $2. My Chip number is
I want to buy my own ChampionChip. I am enclosing $35 payable to Capital Running Co.
First Name:       Last Name:       Race
Address:
City:       State:        Zip:   -
Age on race day:       Sex: M F
Date of Birth:   / /     Shirt Size: S M L XL
Home Phone:   - -     E-Mail:

Credit Card: MC Visa --- Exp:

Cardholder's Signature (Mandatory) __________________________________________

Waiver/Release Must be Signed Before Mailing:

I know that running is a potentially hazardous activity and I should not enter unless I am medically able and properly trained. I assume all risks associated with running in this event including, but not limited to, falls, contact with other participants, the effects of weather and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing the facts and in consideration of your accepting my entry, I, for myself, and anyone else acting on my benefit waive and release the organizers of the Georgetown Classic 10K, J. Paul's, Georgetown Park, Capital Running Company, USATF, plus all sponsors, their representatives and assignors from all claims or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. Further, I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for legitimate purposes.

_________________________________________________________ __________
Signature (parent or guardian if under 18) Date