Saturday, October 12, 2002 -- Oakland, MD
Autumn Glory 5K (iPO Event Id#: 5194)
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Registration Form- Please Print!

Name:________________________________________________

Age on 10/12/02:____ Sex: M  F   Division:  Run  Walk
 
Address:______________________________________________
          
City:__________________ State________  Zip____________

Phone:_______________ Email: _________________________

Sweatshirt Size: S M L XL XXL($2.00 extra)

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 risks associated with running in this race, including, but not limited to falls, contact with other runners, the effect 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 volunteers, 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 12, 2002. I do hereby consent to the use of my name and/or photograph in connection with publicity about the race.

Signature_____________________________________________
                (parent or guardian if under 18)

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Registration: $15.00 if Received by October 1, 2002
$16.00 After October 1, 2002 and Race Day

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