Instructions: Complete this form (including your full mailing address) and sign/date the release. Return the form to your team captain as soon as possible. Be sure to read the team information pages for further details.
OFFICIAL ENTRY FORM | | (type or print clearly) | | |_______________| __________________________________________________________________ LAST NAME FIRST NAME INITIAL MALE  FEMALE  WHEELCHAIR  ________________________ AGE ON 8/13/98 DOB __________________________________________________________________ STREET ADDRESS OR P.O. BOX __________________________________________________________________ CITY STATE ZIP CODE __________________________________________________________________ COMPANY NAME TELEPHONE (BUSINESS) TELEPHONE (RESIDENCE) __________________________________________________________________ CAPTAIN'S NAME CAPTAIN'S TELEPHONE SHIRT SIZE M L XL XXLRELEASE/WAIVER: I know that running and road racing are potentially hazardous activities. I will not enter and run in the August 13, 1998, Healthsource Corporate Road Race unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the event. I assume all risks associated with participation in this event including, but not limited to, falls, contact with other participants, the effects of the weather including high heat and/or humidity, traffic, and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your accepting my application, I for myself and anyone entitled to act on my behalf, waive and release Healthsource, Granite State Race Services, The City of Manchester, Veteran's Park, all volunteers, all sponsors, their representatives and successors from all claims of liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose. I acknowledge that entry fees are non-refundable and non-transferrable for any reason. Athletes who participate in this competition may be subject to formal drug testing in accordance with USA Track & Field rules and IAAF Rule 144. Athletes found positive for banned substances, or who refuse to be tested, will be disqualified from this event and will lose eligibility for future competitions. Some prescription and over-the-counter medications contain banned substances. Information regarding drugs and drug testing may be obtained by calling the USOC Hot Line at 1-800-233-0383.
__________________________________________________________________ APPLICANT SIGNATURE DATE