Blue Moon Run
Friday, June 1, 2007 10:00 PM Start
NCR Trail at Paper Mill Road
Hunt Valley, MD

Make checks payable to: Falls Road Running
Mail to: Falls Road Running, 6247 Falls Road, Baltimore, MD 21209
Do not mail after May 26 - Do not send cash
Type Information, Print, and Sign Entry Form

Event:    Blue Moon  Run 
Entry Fees: $10 prior to May 31st -- $15 on Run Day 
no confirmations or refunds
 Last Name:     
Address:  
City:       State:        Zip:   -
Age on run day:           Sex: M F                                                                                              
Date of Birth:   / /

 Day Phone:   - -  Evening Phone: - -
 

Email:

  I am enclosing my entry fee in the amount of:                              $
 
  (Shirts are sold out, check for waiting list)    
   Total enclosed (absolutely no refunds):                                          $

Waiver/Release Must be Signed Before Mailing:

In consideration of my application being accepted, I hereby for myself, my heirs, personal representatives and executors, waive, release and forever discharge any and all claims for loss or damages which I may have or may hereafter accrue to me against the organizers and sponsors of the Blue Moon Run, including without limitation any sponsors, patrons or supporters and their respective representatives, successors, and assigns, for any and all injuries which might be suffered by me in said event. I attest and verify that I am physically fit and have sufficiently trained for the completion of this race. Further, I hereby grant full permission to any and all of the foregoing to use my name, photographs, videotapes, motion pictures, recordings or any other record of this event for any legitimate purpose, without compensation or remuneration.
I understand that this is a fun run in the dark on an unpaved crushed limestone trail without lighting of any sort beyond what nature will provide. 

_________________________________________________________     __________
Signature (parent or guardian if under 18)                                                              Date