Saturday, October 11, 2003 -- Oakland, MD
Autumn Glory 5K Run & 2 Mile Walk for Sight (iPO Event Id#: 5766)
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Registration Form - Please Print!
Name:______________________________________________________
Age on 10/11/03:____ Sex: M F Division: 5K Run 2M Walk
Address:___________________________________________________
City:_______________________ State________ Zip____________
Phone:_________________________
Sweatshirt Size: S M L XL XXL($2.00 extra)
Waiver of
Liability In consideration of the acceptance of my entry in the
Autumn Glory Run/Walk for Sight, I certify I am physically fit to
participate and I do agree to be bound by all the rules of the race
and all decisions of the official judges. I assume all risks
associated with running in this race, including, but not limited to
falls, contact with other runners, the effect of weather, traffic and
the condition of the road; all such risks being known and appreciated
by me. I do hereby forever release and discharge Oakland-Mtn. Lake
Park Lions Club, all race officials, all volunteers, and any other
race sponsors and their representatives, successors, and assigns of
all foregoing from any and all claims, courses of action, or suits,
which I, or my heirs or assigns, shall or may have arising from or as
a result of my participation in the said race to be held on October
11, 2003. I do hereby consent to the use of my name and/or photograph
in connection with publicity about the race.
Signature________________________________________________
(parent or guardian if under 18)
Registration: $15.00 if Received by October 1, 2003
$16.00 After October 1, 2003 and Race Day
Make Checks Payable to: Oakland - Mtn. Lake Park Lions Club
Mail to: Paul Shockey
920 Broadford Road
Mtn. Lake Park, MD 21550