Race Category (circle one):        Runner          Walker
Your Name:
Address:
Town/State & Zip Code:
Telephone:                                        
E-Mail Address:
Sex:               Age on race day:                Tee shirt size:                Weight For Weight Divisions:
Emergency Contact Name:                                                Emergency Contact Telephone:
 
How Much Money Have You Enclosed:


__________________________________________________________________________________
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 3/13/10. 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