Registration Form for The Young Life GMU 5K & 1M Fun Run
Saturday, November 3, 2001 - 8:30 AM

Make check payable to: Young Life           
Mail to: Young Life 5K, 13710 Ashby Road, Rockville, Maryland 20853-2903
Fax credit card entries to: (301) 871-0006 before Nov 7     Don't mail after Nov 5

Today's Date:   , 2001         Event 5K  1M Fun Run                                                                                              
Entry Fee: $15        $20 on raceday     
 Last Name:      
Address:  
City:       State:        Zip:   -
Age on race day:           Sex: M  F                                                                                              
Date of Birth:   / /     Shirt Size:  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 and indemnify the Young Life, 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. Race management and finish line services by Capital Running Company.

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