gbr.gif (1938 bytes) PDF Entry Form

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Online Entry                                  Photo Copies OK                                Sorry, NO REFUNDS

 

Name
Age (on 5/16/2010) Birth Date Sex
Street
Town State Zip

Circle One Event and your T-Shirt Size (age 13 & up add $6.00 for T-Shirt)

Competitive Non Scored T-Shirt  Size

  • 5K Run (all ages)

  • 1 Mile Run (all ages)

  • 100 Meter Run (ages 4,5)

  • 200 Meter Run (age 6)

  • 400 Meter Run (ages 7-14)
  • 3 Mile Prostate Cancer Walk
  • Tiny Tots Bear-a-thon (age 0-3)

 

  • 1 Mile Fun Walk / Run (all ages)
  • 2-4
  • 6-8
  • 10-12
  • 14-16
  • Adult Small
  • Adult Medium
  • Adult Large
  • XL
  • XXL

Options (check)

  _____  Pizza  Buffet  ($ 6.00 extra)   _____ T-Shirt (age 13+) ($6 extra) _____ Extra Race ($6)

I am medically able and properly trained to participate in this event.    I assume all risks associated with participating in this event including, but not limited to falls, contact with othe participants or spectators, the effects of weather, traffic and conditionas of the road, all such risks being known and appreciated by me.    I, for myself and anone entitled to act on my behalf, waive and release the Needham Track Club, the Town of Needham, all sponsors, their representatives and successors for all claims or liabilities of any kind arising out of my participation in this event.

Signature _______________________________________      Date ________________

                                         (parent or guardian if under 18)

 

Phone _____________________              Email    _________________________

I can volunteer at the meet: Name _________________________ Phone __________________ Email ____________________

Advance Registration Fee       (received by May 6)                                          
Entry: $15.00 Pizza Buffet:   add $6.00
Advance Registration Fee (received by May 13)
Entry: $18.00   T-Shirt (age 13+): add $6

Send Entry to:        Needham Track Club            53 Coulton Park             Needham, MA      02492

Registration Fee:

Received by May 6: $15

Received by May 13: $18

Race Day: $20