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RECORDS

COURSE

 2008 CPL ENTRY FORM

Fees:
5K--$18.00 by 10/13/08; $20.00 thereafter and on race day
5K USATF--$16.00 by 10/13/2008
1 Mile Ramble--$10.00
Kids' Dashes--$7.00

Please make checks payable to and mail to:
The Cerebral Palsy League
61 Myrtle Street
Cranford, NJ 07016
 

Last Name:_________________________________________  First Name:______________________________

Address:_______________________________________

City:__________________________________________

State:________ Zip:____________

Phone:___________________    E-mail:_________________________ 

Circle One:   5K          1 Mile Ramble       Kids' Dashes

Sex:  Male  Female

Age (Day of Race):____________

Date of Birth:_________________

2008 USATF#_________________

Adult T-shirt Size: ___ S  ___ M  ___ L  ___XL

Kids T-shirt Size: ___ YS  ___ YM  ___ YL

I can't participate but here's my donation of $___________

Waiver Release: In consideration of this entry being accepted, I hereby for myself, heirs, executors, & administrators waive & release any claims I may have against The Township of Cranford, The Cerebral Palsy League, Inc., On Your Mark Productions, their staff, officers, volunteers, successors and assigns for any and all injuries that may be suffered by me in this event. Further, I state that I am physically able to participate in this event.

Signature (Parent or Guardian if under 18 years of age):

______________________________________________

Date: ___________________