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Thursday, May 17, 2001 -- Connellsville, PA
Anchor Glass / Rolling Rock 5K (iPO Event Id#: 3173)

Rolling Rock Logo
Latrobe Brewing Co.
Proud race sponsor
Make checks payable to: 1341 Committee

Mail entry forms to:
Anchor Glass Container Corporation
Anchor Glass/Rolling Rock 5K Race
1926 Bladridge Street
Connellsville, PA 15425

Return to the race [Details Page]


NAME:_____________________________________________________   

Male:______    Female:______   Date Of Birth:_____________

ADDRESS:__________________________________________________

CITY:_______________________ ST:________   ZIP:___________

PHONE #:__________________________________________________

RUNNER:_____     WALKER:_____      AGE ON 05-17-01:_______   

T-SHIRT SIZE:   SM     M    L    XL       
WAIVER: In consideration of my entry being accepted, I herby, for myself, my heirs, executors, administrators, successors and assigns, waive, release, and discharge and and all rights and claims for damages or liability of any kind relating to or arising out of my participation in the Anchor Glass/Rolling Rock 5k race, even though the liability may arise of negligence and carelessness on the part of the entities or persons named in this waiver and release including but not limited to weather, high heat, humidity, traffic, conditions of the road. The following organizations or individuals are released from liability by this waiver or release: The race director, the organizers, officers, directors, members volunteers, employees, and sponsors, the Borough of South Connellsville, and any or all other agents, officials, or sponsors of the race. I attest and verify that I am physically fit to participate, my condition has been verified by a licensed medical doctor and I assume entry into this race at my own risk. If I should suffer an injury or illness, I authorize the officials of this race to use discretion to administer first aid and or have me transported to a medical facility, and I take full responsibility for this action. I hereby grant full permission to any and all of the foregoing to use any photographs, videotapes, motion pictures, recordings or any other record of this event which may include my voice, description or likeness, for any purpose whatsoever. I have read the above conditions and accept them as shown by my signature and I understand that I am entering this event at my own risk.
__________________________________________________________   
SIGNATURE REQUIRED Parent must sign if under 18