Men in Kilts 5K
Saturday, November 10, 2007 8:00 AM Start
Maryland State Fairgrounds
Timonium, MD

Make checks payable to: Men in Kilts 5K
Mail to: Falls Road Running, 6247 Falls Road, Baltimore, MD 21209
Do not mail after November 5 - Do not send cash
Type Information, Print, and Sign Entry Form

Event:    5K   
Entry Fees: $12 prior to Sept  17st -- $15 thereafter 
no confirmations or refunds
 Last Name:     
Address:  
City:       State:        Zip:   -
Age on race day:           Sex: M  F                                                                                              
Date of Birth:   / /

 Shirt Size: M  LG  XL                 Waist Size (for kilts)                  

Day Phone:   - -  Evening Phone: - -
 

Email:

  I am enclosing my entry fee in the amount of:                              $
  I am enclosing my extra funds in the amount of $15 for              $ 
       Baltimore Irish Festival Tee-Shirt
  I am inclosing an extra $40 to buy or rent a kilt ($20 refunded   $
       upon return for rentals)
 
   Total enclosed (absolutely no refunds):                                            $

Waiver/Release Must be Signed Before Mailing:

In consideration of my application being accepted, I hereby for myself, my heirs, personal representatives and executors, waive, release and forever discharge any and all claims for loss or damages which I may have or may hereafter accrue to me against the organizers and sponsors of the Men in Kilts 5K Run/Walk, including without limitation any sponsors, patrons or supporters and their respective representatives, successors, and assigns, for any and all injuries which might be suffered by me in said event. I attest and verify that I am physically fit and have sufficiently trained for the completion of this race. Further, I hereby grant full permission to any and all of the foregoing to use my name, photographs, videotapes, motion pictures, recordings or any other record of this event for any legitimate purpose, without compensation or remuneration.

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