-Do not mail out after 3/8/12-

Name:
Address:
Town, State & Zip Code:
Telephone:                                                  E-Mail Address:
Sex:                    Age on race day:                     T-shirt size:                     Weight for Weight Divisions (optional):
Emergency Contact Name:                                                               Emergency Contact Telephone:
Favorite Irish Pub (choose one):            The Burren               Joshua Tree               Olde Magoun Saloon
                     On the Hill Tavern               The Pub               Sligo Pub               Other _________________________
Family is from Ireland          Generation (e.g., native, 1st, 2nd, etc.):                    
                                           Town/County:                                                       Republic or Northern Ireland
Amount enclosed (race fee $32.00):


__________________________________________________________________________________
Signature/ Signature of parent if under 18
  		Date  
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 of Somerville where the event is being held in, organizers, B.A. Event Promotions, Somerville Striders Athletic Club, Paul Collyer, all sponsors of the race and I attest and verify that I am physically fit and sufficiently trained for this event on 3/18.12. I also understand that there are no refunds regardless of the circumstances. I also understand that I must be present to receive any merchandise I have ordered - WE WILL NOT MAIL OUT

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