Race Entry Form

Stratton Faxon New Haven Road Race
Labor Day, Monday September 2, 2013, 8:15a.m., Kids Race, 8:40 a.m., 20K, 5K

After completing, Please print this form and mail to:
New Haven Road Race
PO Box 1893
New Haven, CT 06508

______ Check here if you qualify for a complimentary entry for raising $250 or more for the Cindy Lynn Sherwin Foundation, the PKD Foundation, Bpositive Foundation for Children with Cancer, Team in Training, New Haven Legal Assistance Association, United Way or New Haven Home Recovery.  Make check payable to the respective organization and mail with entry form.

              

Please include check or money order payable to the New Haven Road Race
Entry Fees are non refundable.

Last: MI: First:
Address:
City: ST: Zip:   Phone #
Clydesdale (Men 200+ lbs & Women 150+ lbs)   Wheelchair  
Police/Fire Judge/Lawyer (20K only)   Military
Sex: Male: Female: Age: Date of Birth:


USATF No.  
Email:
New Haven Road Race 20K 5K 1/2 Mile*
By July 10 $45 $28 $8
July 10 - August 15 $50 $30 $9
After August 15 $55 $33 $10

*Free entry for kids who are New Haven residents in 1/2 mile run and registered by mail by August 31, 2013.

** No race day registration!



20K & 5K FREE Short Sleeve Technical T-shirt / Kids' Race Short Sleeve T-shirt
Small
Medium
Large
X-Large

Additional t-shirts may be purchased for $20 per shirt (includes shipping).  All orders received by 8/15/13 will be mailed.  Allow 2 weeks for delivery.


I know that running a road race is a potentially hazardous activity. I will not enter and run unless I am medically able and properly trained.
I agree to abide by any decision on any race official as to my ability to safely complete the run. I assume all risks with running this event,
including but not limited to falls, contact with other participants, effects of weather, including high heat and humidity, traffic and the condition
of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your
accepting my entry, I, Myself and anyone entitled to act in my behalf waive and release the City of New Haven,
Stratton Faxon Law Firm, race officials, volunteers, and all sponsors from all claims or liabilities of any kind
arising out of my participation in this event, I grant permission to all of the foregoing to use any photographs, Motion pictures,
recordings or any other record of this event for any legitimate purposes. I know that dogs, bicycles, in-line skates, and baby joggers are not
allowed on the course.



Signature
(Parent must sign if competitor under 18) _____________________________Date ____________



On-Line Registration is provided by
Click for 2012 Race Entry