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Entry Form: Checks payable to "City of Sierra Madre". Send a self-addressed stamped envelope to receive conformation.
No shirt ($20) Adult $22 Youth $20
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Last Name First Name
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Number & Street Name City State
|__|__|__|__|__| ( ) |__|__|__|-|__|__|__|__| |__| |__| |__|__| Circle Age Division:10-14 15-19 20-29 30-39 40-49 50-59 60+
Zip Code Area Day Phone Male Female Age
Circle T-shirt size: Sm Med Lg X-Lg Souvenir Order: Adult T-shirt $10.00 Sm Med Lg X-lg
RELEASE WAIVER: intending to be legally bound, and assume all risk in connection with or in any way related to my participation in the Mt. Wilson Trail Race, I certify that, to the best of my knowledge, my training and health are adequate for me to compete safely in this run. In consideration of your accepting my entry I assume all related risks and do hereby for myself, executors and administrators, waive and release forever any and all rights and claims or damages I may hereafter occur to me against the persons or organizations affiliated with the race, including but not limited to the City of Sierra Madre, Race Chairperson and Committee members, The Athletic Congress, and any and all supporters of the race, their representatives, successors and assigns, for any injuries suffered by me while participating in the Mt. Wilson Trail Race.
Signature________________________________________________________Date___________Parent (if under 18) _______________________________
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