Feaster Five Road Race

Race Entry Form -- Thanksgiving Day
November 22, 2007

To register for MVS Feaster Five Road Races fill in the application below,
print it, and send it with a check payable to
DMSE/Feaster to Feaster Five Road Race, P.O. Box 80067, Stoneham, MA 02180.

First Name

Last Name

Age on 11/22/07: || Sex Female Male Projected Time

Address:
Town/City:
State Zip

Home Phone: Work Phone

Race:	Entry fee: $25 before and on 11/17; $30 after 11/17 5 mile race or walk 5K race or walk 5 mile wheelchair Entry fee: $5.00 Kid's K (1/2 mile)
Souvenir Feaster Race Glasses ($8 each), Quantity:
Check here if you would like to include an extra $5 to be donated to the Merr. Valley Hospice Check here if you are part of a registered family (see Feaster Family contest rules)
Amount of check enclosed: Your entry fee includes 25 cents for the Feaster Five Commemorative Edition of The Eagle-Tribune for race day, November 22. If you do not wish to receive this Commemorative Edition, please deduct 25 cents from your check total.

Remember -- You must sign below !! One person per entry form. Photocopies accepted.

I know that running is a potentially hazardous activity. I should not enter and run the race unless I am medically able and properly trained. I agree to abide by any decisions of a race official relative to my ability to safely conclude the run. I assume all risk associated with running, including, but not limited to, falls, contact with other participants, the affects of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, I, for myself and anyone entitled to act on my behalf, waive and release the Merrimack Valley Striders, DMSE, the Town of Andover, Eagle-Tribune, HPHC, all sponsors, their directors, officers, employees, agents, representatives, and successors from all claims or liabilities of any kind or nature whatsoever arising out of my voluntary participation in this race even though that liability may arise out of negligence or carelessness on the part of the persons named on this waiver.

_____________________________________________

Signature (Parent or Guardian if under 18)

If you already own a ChampionChip, please write the chip number here:
[2 letters, 5 numbers] ________________________

Make checks payable to: DMSE/Feaster.
Mail to: Feaster Five Road Race, P.O. Box 80067, Stoneham, MA 02180