13th New Balance Moonlight Run 5K
www.roadntracksports.com

- NewMil Bank - DWD - Chemical Marketing - Litchfield County Times - Good Fellow Homes

Please Mail Application to:  Road & Track Sports / 29 Main St. / New Milford, CT 06776

In consideration of the acceptance of the 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 Road & Track Sports, the Town of New Milford, New Balance and any and all associate parties and sponsors, for any and all I injuries suffered by me at this event. I attest and verify that I am physically fit and sufficiently trained to participate in this 3.1 mile race. I hereby grant permission to any and all of the foregoing to use my photographs, videotapes, or any other record of this event without compensation.

PRINT CLEARLY:______________________________________________________________

STREET: _____________________________________________________________________

CITY : ______________________________________STATE : _________ZIP: _____________

MALE AGE ____ FEMALE AGE____  CHIP NUMBER   __ __ - __ __ __ __ __

Pre $13.00 ___Post $15.00 ___ Postmarked After May 1st.

T- Shirts Add $8.00   Sm ___ Med  ___    Large ____   X-LARGE  ____ 100% Quality Cotton  Shirt  

NO REFUNDS   

Race Day Reg.  $20.00

Total Enclosed  $  ___________

SIGNATURE :________________________________________________________

Your application will be returned if you do not sign it or it is missing your age.
Wallie Jahn- Road & Track Sports- 860 354 9191