St. Paddy's 4 Miler - Application

14th Annual St. Paddy's 4 Miler - March 14th, 2009

Checks Payable to GFLRRC, No entry accepted without fee. No Refunds.
Mail to: St. Paddy's 4 Miler, PO Box 2512, Ft Lauderdale, FL 33303-2512
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E-mail

Last Name
First Name
Age Male
Female

Mailing Address - Street (include Apt. No and/or C/O)

City
State
Zip Code

- -
Birthdate - MM/DD/YYYY - -
Telephone

Entry Fees:

Early Registration
$20.00 - GFLRRC Members
$25.00 - Non-members
$10.00 - Student (19 & under)
$3.00 - Youth Mile*
$3.00 - Munchkin Dash (12 & under)*

Race Day
$30.00 - 4 Miler
$5.00 - Youth Mile*
$5.00 - Munchkin Dash*

*No T-Shirt
Event
4 Miler Run
4 Mile Fitness Walk
Youth Mile
Munchkin Dash T-Shirt Size
S
M
L
XL

RELEASE FORM (Mandatory)
In consideration of accepting this entry, I, the undersigned, intending to be legally bound hereby, for myself, my heirs, executors and administrator, waive and release any and all rights and claims for losses and damages I may have against the Greater Fort Lauderdale Road Runners Club, race directors, their officers, directors, members and volunteers, any and all sponsors including other parties and their representative successors, and assigns for any and all injuries suffered by me in said event. I attest that I am physically fit and have sufficiently trained for the competition of this athletic event and competition which I am voluntarily entering at my own risk. My physical condition has been verified by a licensed medical doctor. Further, I hereby grant full permission to any and all foregoing to use photographs, videotapes, motion pictures, recordings or any other record of this event for any purpose whatsoever. USE OF HEADPHONES, OR ROLLING SKATES/INLINE SKATES, BABY JOGGERS ARE NOT PERMITTED ON THE COURSE. NO ONE MAY ENTER THIS EVENT WITHOUT SIGNING THIS OFFICIAL WAIVER.

_______________________________ _______________

Signature of Runner - Signature of Parent or Legal Guardian (if under 18) Date

E-mail
Last Name	First Name	Age	Male Female
Mailing Address - Street (include Apt. No and/or C/O)
City	State	Zip Code
- - Birthdate - MM/DD/YYYY	- - Telephone

Entry Fees: Early Registration $20.00 - GFLRRC Members $25.00 - Non-members $10.00 - Student (19 & under) $3.00 - Youth Mile* $3.00 - Munchkin Dash (12 & under)* Race Day $30.00 - 4 Miler $5.00 - Youth Mile* $5.00 - Munchkin Dash* *No T-Shirt	Event 4 Miler Run 4 Mile Fitness Walk Youth Mile Munchkin Dash	T-Shirt Size S M L XL

RELEASE FORM (Mandatory) In consideration of accepting this entry, I, the undersigned, intending to be legally bound hereby, for myself, my heirs, executors and administrator, waive and release any and all rights and claims for losses and damages I may have against the Greater Fort Lauderdale Road Runners Club, race directors, their officers, directors, members and volunteers, any and all sponsors including other parties and their representative successors, and assigns for any and all injuries suffered by me in said event. I attest that I am physically fit and have sufficiently trained for the competition of this athletic event and competition which I am voluntarily entering at my own risk. My physical condition has been verified by a licensed medical doctor. Further, I hereby grant full permission to any and all foregoing to use photographs, videotapes, motion pictures, recordings or any other record of this event for any purpose whatsoever. USE OF HEADPHONES, OR ROLLING SKATES/INLINE SKATES, BABY JOGGERS ARE NOT PERMITTED ON THE COURSE. NO ONE MAY ENTER THIS EVENT WITHOUT SIGNING THIS OFFICIAL WAIVER.

_______________________________		_______________
Signature of Runner - Signature of Parent or Legal Guardian (if under 18)		Date