Name:  
     Address:  
        City:  
       State:    Zip:   Home Phone: 
Date of Birth:   Age on race date: 

       Event: 2 Mile 5 Mile

      Gender: M F     Shirt size: S M L XL

  Running club: 

  Entry fee:  $15 (received by July 1, 2009)
              $14 (for MRC members, received by July 1, 2009)
              $20 Race Day Registration (print this form and bring it to race)

Waiver: I acknowledge that running a road race is a potentially hazardous activity and I
should not run unless I am medically able and properly trained. I assume all risks associated
with running the 2009 Run For Independence, held on July 4, 2009, including, but not
limited to falls, contact with other participants, traffic, conditions of the road, and effects
of weather. Having read this waiver and in consideration of entry, I for myself, and/or anyone
entitled to act on my behalf, waive and release the Merced Running Club, the City of Atwater, the
Atwater Fourth of July Committee, Atwater Chamber of Commerce, and all sponsors and officials
from all claims or liability arising out of my participation in this event.

_______________________________  _____________ _____________________________________
Signature                        Date          Parent's Signature if under 18

			[ Up ] [ Home ]