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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 |
| Ya-Ya's Short Sleeve Tee Shirt: $15.00 extra SIZE: S M L XL XXL |
| Ya-Ya's Long Sleeve Tee Shirt: $18.00 extra SIZE: S M L XL XXL |
| Ya-Ya's Women's Tank Top: $18.00 extra SIZE: S M L XL XXL |
| Ya-Ya's 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 #442, 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 6:00 P.M.-6:45 P.M. on 5/28/09
-WE WILL NOT BE MAILING OUT-
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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 #1
Worcester, Massachusetts 01609
(617) 625-2140
