BRIAN'S RUN AND WALK
DECEMBER 2nd, 2007
 ENTRY FORM
 REGISTER ONLINE

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First Name                                        Last Name

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Address                                         City/State/Zip

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Phone

Age on Race Day_____________ Male [ ]             Female [ ]

Event Entered (Check One) NOTE: 10K Racers - check either 10K or Weight Division category

[ ] 1 Mile Open Fun Run
[ ] 1 Mile Children's Fun Run (11 years and under)
[ ] 5,000 Meter Run/Walk
[ ] 10,000 Meter Race
[ ] 10,000 Meter Race - Wheelchair Division - (Bike escort available)
[ ] 10,000 Meter Race - Clydesdale Division - Men weighing 200+ lbs.
[ ] 10,000 Meter Race - Athena Division - Women weighing 150+ lbs.
[ ] I am unable to participate but wish to make the enclosed donation.
[ ] I would like to be a Brian's Run volunteer (Please contact me)

Pre Registration- Before 11/19/2007 - Runners & Walkers

  • $20 for 10K and 5K if postmarked by 11/19/07.
  • $12 for 1-Mile Fun Run/Children's Run if postmarked by 11/19/07.

Race Weekend Registration - Runners & Walkers

  • $25 for 10K & 5K (And for those postmarked AFTER Nov. 19, 2007). Race applications will not be processed if postmarked after Nov. 19, 2007. Please bring the application and post-entry fee on race weekend for processing during registration hours.

  • $12 for both 1 mile fun runs

Disclaimer
Disclaimer: In consideration of the furtherance of your purpose, objective and work, and in consideration of your permitting me to participate in your "Brian’s Run" event on behalf of myself, my heirs, executors, administrators and assigns, I hereby waive and release any and all rights and claims for damages which I may have against you, the municipalities through which the event will take place, commonwealth of Pennsylvania, as well as any other person connected with the event, their heirs, executors, administrators, successors and assigns for any and all injuries which I may suffer while taking part in the event or as a result thereof.

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Date                                  Signature of Runner (required)

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Signature of Parent or Guardian if under 18 years