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Saturday, October 13, 2007 -- Oakland, MD / Broadford Lake Park
Oakland Mtn. Lake Park Lions 5K Run / 2Mile Walk for Sight (iPO Event Id#: 10329) --- Return to the Details Page

Make checks payable to: Oakland - Mtn. Lake Park Lions Club
Mail to: Paul Shockey, 920 Broadford Road, Mtn. Lake Park, MD 21550

REGISTRATION FORM - PLEASE PRINT:

Name: __________________________________________________________

Age on 10/13/07 _________        Sex: Male_____ Female_____

Address: _______________________________________________________

Street:  _______________________________________________________

City: _____________________________  State: _____  Zip: ________

Sweatshirt (Circle one): S  M  L  XL  XXL ($2 extra)  

5K Run: ___  2 Mile Walk ___      Phone (_______) ______________
Waiver of Liability: In consideration of the acceptance of my entry in the Autumn Glory Run/Walk for Sight, I certify I am physically fit to participate and I do agree to be bound by all the rules of the race and all decisions of the official judges. I assume all risk associated with running in this race, including, but not limited to falls, contact with other runners, the effects of weather, traffic and the condition of the road; all such risks being known and appreciated by me. I do hereby forever release and discharge Oakland - Mtn. Lake Park Lions Club, all race officials, all volunteer workers, and any other race sponsors and their representatives, successors, and assigns of all foregoing from any and all claims courses of action or suits, which I or my heirs or assigns, shall or may have arising from or as a result of my participation in the said race to be held on October 13, 2007. I hereby consent to use of my name and /or photograph in connection with publicity about the race.
 
X _________________________________________________________
 Signature of Participant    

X _________________________________________________________
 Signature of Parent/Guardian (If under 18)