Race Entry Form
Stratton Faxon New Haven Road Race
Labor Day, Monday September 6, 2010, 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 $100 or more for the Cindy Lynn Sherwin Foundation,
Connecticut Children's Medical Center, Leukemia & Lymphoma Society's Team in Training, or The American Cancer
Society. 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 # | ||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| USATF No. | |||||||||||||||||||||||||||||||||||||||||
| Email: | |||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| 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, NewAlliance Foundation, 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 2010 Race Entry
