WINDRUNNER 10K RACE – AUGUST 21, 2011

WINDRUNNER 10K 2011 ENTRY FORM. PLEASE PRINT CLEARLY BIB # ______________

FIRST NAME: _________________________ LAST NAME ________________________________________

STREET ADDRESS:_________________________________CITY:___________________________________,

ST:____ ZIP:________ DAY PHONE: (_____) ______-_________ NIGHT PHONE: (_____) _____-________

EMAIL: ______________________________________________

DATE OF BIRTH: ______/______/______ AGE ON 8/21/11: ______ MALE: ____ FEMALE: ____

T-SHIRT SIZE (as available): S M L XL (Circle)

REGISTRATION FEES: $30, $3 discount for CARA members, ($35 on race day); DONATION TO SPECIAL OLYMPICS: $______. TOTAL = _________

Have you run this race before? YES____ NO_____

Make check(s) payable to: Lisle Windrunners.

Mail to: Lisle Windrunners, PO Box 3574, Lisle, Il 60532

In consideration of your acceptance of my registration, I do hereby,  for myself and anyone else on my behalf, waive and release the Lisle Windrunner Club and all sponsors, all agents, affiliates and volunteers from any and all claims for damages whatsoever created as a result of my participation in this event, including bodily injury. I attest and do hereby verify that I am physically fit and have trained sufficiently for this event, and that I am aware of the risks involved in running at this warm time of the year, and intend by this release to assume full responsibility to anything that may happen to me or anyone else on my behalf.

Applicant’s Signature: __________________________________________ Date: ____/____/_2011

Parents Signature required if the applicant is under age 18 ___________________________________