2009 Francestown Five

Application

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Francestown Five

PO Box 113

Francestown NH  03043-9999

______________________________           _________________________

Last Name                                                          First Name

______________________________________________________________

Address

___________________      ________________    __________   

Town                                      State                              Zip code       

_________________     ___________     ____________       ____  

Telephone                        Date of birth       Age on 9/7           Sex 

____________________________   

E-mail address                                      

Entry-    _____   Five mile race (no walkers please)     

             _____   Five kilometer fun run (walkers yes!)

             _____   Children's race

Fees-     $12.00   Five mile race or 5k fun run entry received before 8/15                $18.00   Five mile race or 5k fun run entry received after 8/15

                 Free   Children's race

               $10.00   T-shirt (optional, application must be postmarked by 8/15)

Total  $_________         Make check payable to F.I.H.S.

T-shirt size ($10.00 each)-  Circle

          Small            Medium           Large           Extra large

I understand that running a road race is a potentially hazardous activity which could result in injury or death.  I should not enter and run unless I am medically able and properly trained.  I agree to abide by any decision of a race official relative to any aspect of my participation in this event, including the right of any official to deny or suspend my participation for any reason whatsoever.  I assume all risks associated with running in this event, including but not limited to:  falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the condition of the road, all such risks being known and appreciated by me.  I understand that bicycles, skateboards, roller skates, and roller blades are not allowed in the race and I will abide by this guideline.  Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Francestown Improvement and Historical Society, the organizers of the Francestown Five race, the town of Francestown NH, and all sponsors and their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.  I grant permission to all foregoing to use any photographs, motion pictures, recordings or any other record of this event for any legitimate purpose.

________________________________________                           __________________                                                          Signed (parent signature if under age 18)                          Date

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2009 RACE INFORMATION

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