Beardsley Beast 5k Saturday May 3, 2014 Pre- Registration - $20 Mail-in Registration - $20 (by 4/19)

Race Day registration - $25 Under 16 - $10

Liability: PLEASE UNDERSTAND THAT THIS EVENT IS RAIN OR SHINE & NON-REFUNDABLE!
In consideration of accepting this entry, I hereby for myself, my heirs, executors, and administrators, waive and release any and all rights and claims for damages I may have against the named organization, sponsors, charities, property owners, facilities, MS Running Productions & Timing service, HITek Racing, any and all sponsors and each of their directors, officers, employees, agents and representatives for any and all injuries, damages and/or claims of any description which might arise out of this event and all activities in any way connected therewith. I attest that I am physically fit and have sufficiently trained for the event in which I am participating.

Race Day entry Form/ pre-reg. mail in Please Print Neatly - it must be readable Last : ________________________ First: _________________________ BIB #: ________________ (to be filled in by staff only) Sex: ______ Your age TODAY: _______ Date of Birth: ____ / ____ / ______ Street Address: ______________________________ City: __________________________ State: ________ Zip: _____________

T-Shirt size: XL L M Sm Email ___________________________ YOUR SIGNATURE MUST BE ON THIS WAIVER - Parent/guardian if UNDER 18 Please sign here: _____________________________________________ Parent or Guardian signature here: _______________________________ Mail to: Chris Kinsley (by April 19 postmark)** 278 Fairview Ave. Fairfield, CT 06824