Saturday, October 16, 2004 -- Oakland, MD
Autumn Glory 5K Run (iPO Event Id#: 6506)

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Registration Form - Please Print!

Name:______________________________________________________

Age on 10/16/04:____  Sex: M  F   Division: 5K Run  2M Walk
 
Address:___________________________________________________
          
City:_______________________ State________  Zip____________

Phone:_________________________

Shirt 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 16, 2004. 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)