Frigid Fiver Frigid Fiver
First Name: [ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
Last Name: [ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
AGE: [ ][ ] SEX: [ ]
Enclosed: $15.00 [ ]
Street Address ______________________________________________
Town:_________________________ State:________ ZIP:__________
Telephone:_______________
In consideration of my being a participant in the 5 mile road race on February 3, 2008 in Newburyport, MA, I, the undersigned do hereby agree to assume all risk of harm, injury, or loss of whatever nature resulting at said event and release, discharge, and forever hold harmless the Newburyport Rotary Club and all sponsors or contributors agents associated with this event, from any and all claims which might arise from my participation in said race or from traveling to or returning therefrom.
SIGNATURE: (GUARDIAN IF UNDER18) _________________________________________ Date:_______________
Checks payable to: Newburyport Rotary Club . Mail To: Tom Farrell, PO Box 831, Newburyport, MA, USA, 01950. For more information, contact: Tom Farrell at tfarrell88@hotmail.com
Click here to see a Figid Fiver race information.
