All proceeds to benefit the Bruce Ellis Memorial Scholarship Fund
"Bruce Ellis Memorial 5K Road Race" Race Preregistration
FIRST NAME: ___________________________LAST NAME:__________________________________ ADDRESS:____________________________________CITY:___________STATE:_____ZIP:________ TELE #_________________________ RACE CATEGORY: SEX:_____ AGE on 11/5/05:______
Enclosed: Preregistration fee ($14 prior to 10/25, $17 after 10/25): $ Optional additional contribution to the Bruce Ellis Memorial Scholarship Fund: $ Total: $
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 in the event including, but not limited to :falls, contact with other participants, the effects of weather, traffic, and the conditions of the road and trails, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of you accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release all sponsors, Exeter Health Resources, Inc. and all subsidiary corporations, the Winner’s Circle Running Club, the Town of Exeter, Phillips Exeter Academy, representatives, successors, and volunteers from all claims or liabilities of any kind arising out of my participation in this event even though the liability may arise out of negligence or carelessness on the part of the person named in the waiver. 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 purpose.
SIGNATURE: (guardian if under 18) ______________________________ DATE: ____________
Make checks payable to: "Bruce Ellis Road Race" c/o George and Phillips, 173 Water Street, Exeter, NH 03833. The race fee is $14 for all applications received by 10/25, $17 after 10/25. Race day registration (also $17) from 8:00 A.M. to 9:30 A.M. in the lobby of Synergy Health and Fitness.
For additional information contact Richard Evans at 603-580-7034 or revans@ehr.org.
Click here for "Bruce Ellis Memorial Road Race" race information.