5Km Run
1 Mile Fitness Walk
-Please circle one-
My Membership # is _______________
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| Your Name: |
| Address: |
| Town/State & Zip Code |
| Telephone Number: E-Mail Address: |
| Sex: Age: Weight for Weight Divisions: |
| Race Tee Size: Please Circle S, M, L, XL & XX-L |
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Friends of Harpoon Verified
Membership Discount: $15.00 entry fee Yes I am a
"Friend of Harpoon" My Membership # is _______________ |
| Running/Multi-Sport Club or Worcester College: |
| Circle the extra merchandise you are purchasing in the below boxes - CIRCLE SIZE |
| Canal Diggers 5Km Short Sleeve Tee Shirt: $15.00 extra SIZE: S M L XL XXL |
| Canal Diggers 5Km Long Sleeve Tee Shirt: $18.00 extra SIZE: S M L XL XXL |
| Canal Diggers 5Km Women's Tank Top : $18.00 extra SIZE: S M L XL XXL |
| Canal Diggers 5Km Men's Tank Top : $18.00 extra SIZE: S M L XL XXL |
| Canal Diggers 5Km Coffee Mug: $10.00 |
| How Much Money Have You Enclosed: |
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| WAIVER: In consideration of my acceptance of this entry I intend to be legally bound, hereby for myself, my heirs, executors and administrators waive and release any and all claims for personal damage I may have against the City of Worcester, Massachusetts where the event is being held, organizers including B.A. Event Promotions, Somerville Striders AC, Paul Collyer, Fallon Community Health Plan, Worcester Ancient Order of Hibernian, Harpoon Brewery, sponsors of the race, and I attest and verify that I am physically fit and sufficiently trained for this event on September 14, 2008. I also understand that there are no refunds regardless of the circumstances and that I must be present to receive my merchandise. |
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Signature of parent if under 18 |
Please address all checks and money orders to B.A. Event
Promotions and mail to
B.A. Event Promotions 224 1/2 Chandler
Street #2 Worcester, Massachusetts 01609
(617) 625-2140
