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| Your Name: |
| Address: |
| Town/State & Zip Code |
| Telephone Number: E-Mail Address: |
| Sex: Age: |
| 4.2 Mile Runner 2.6 Mile Walker (Please Circle) |
| Circle the merchandise you are purchasing in the below boxes - CIRCLE SIZE |
| Brie Burger Short Sleeve Tee Shirt: $15.00 extra SIZE: S M L XL XXL |
| Brie Burger Long Sleeve Tee Shirt: $18.00 extra SIZE: S M L XL XXL |
| Brie Burger Women's Tank Top: $18.00 extra SIZE: S M L XL XXL |
| Brie Burger Men's Tank Top: $18.00 extra SIZE: S M L XL XXL |
| How Much Money Have You Enclosed: |
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WAIVER: In consideration of my
acceptance of this entry I intend to be legally bound, hereby for myself, my
heirs, executors and administrators
waive and release any and all claims for personal damage I may have against the
city or town that the event is being held in, organizers, B.A.
Event Promotions, Somerville Striders AC, Paul Collyer, American Legion
Marsh Post, sponsors of the race, and I attest and verify that I am
physically fit and sufficiently trained for this event. I also
understand that there are no refunds regardless of the circumstances and
that I must be present to receive my merchandise at the time expressed to me
prior to purchasing 5:45 P.M.-6:29"29 P.M. on 8/23/07
| _______________________________________________________________________________________________________________ | |||
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| Signature of
parent if under 18 |
Please address all
checks and money orders to B.A. Event Promotions
and mail to
B.A. Event Promotions 224 1/2 Chandler Street #2
Worcester, Massachusetts 01609
(617) 625-2140
