St Patrick's Celebration Irish Pub Run
Saturday, March 13, 2010 8:00 AM Start
Slainte's 1702 Thames Street
Fells Point
Baltimore, MD

Make checks payable to: Falls Road Running
Mail to: Falls Road Running, 6247 Falls Road, Baltimore, MD 21209
Do not mail after March 8 - Do not send cash
Type Information, Print, and Sign Entry Form

Event:    St Patrick's Celebration Pub Run 
Entry Fees: $10 prior to March 15th -- $15 on Pub Run Day 
no confirmations or refunds
 Last Name:     
Address:  
City:       State:        Zip:  
Age on run day:           Sex: M F                                                                                              
Date of Birth:   / /

Pre-order           Waist Size (for kilts)             Kilts are $25 each

Pre-order            St Patrick's Running Shoe        Running Shoes are $65

Day Phone:   - -  Evening Phone: - -
 

Email:

 

 I am enclosing my entry fee in the amount of:                                     $
 
  I am inclosing an extra $25 to buy a kilt                                              $
  
I am inclosing an extra $65 to reserve Shamrock Running Shoes   $

      
   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 Saint Patrick's Day Pub 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 on sidewalks, not open roads.  The streets and intersections are NOT blocked by police officers, and I must and will obey all traffic laws and regulations for my personal well-being. 

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