Name
Phone
Address Email
City
State Zip
Birth Date
T-shirt Size (if shirts are available) S M L
XL
Runners
Circle Division
Male
Female
13 & Under 13
& under
14 - 19
14 - 19
20 - 29
20 - 29
30 - 39 30
- 39
40 - 49
40 - 49
50 - 59 50
- 59
60 - 69
60 - 69
over 70
over 70
I know that running a road race is a potentially hazardous activity. 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 my ability to safely complete the
run. I assume all risks associated with running this event including, but not limited to: falls, contact with other participants,
the effect of weather (including rain, wind and snow, high heat or humitity), the traffic and the condition of the road. In
consideration of your accepting my entry, I for myself and anyone entitled to act on my behalf, waive and release Paula Jean
Lunt, the Town of St. George and all other sponsors, their representatives and successors for all claims of liabilities arising
out of my participation in this event.
Signiture___________________________________Date_____________
Parents Signiture if under 18_________________________Date_______
Please make check payable to: American Lung Association - Maine
Total Fees Paid $__________ Check Number
_____________
