St. Joeseph's Medical Center We Remember 5 Mile Run

St. Joseph Medical Center Run To Remember 5k Run and 1 Mile Walk
Thursday, September 11, 2008 - 7:00 AM
Baltimore City Police Headquarters, 601 E. Fayette Street, Baltimore, MD

Make checks payable to: SJMC Run To Remember
Mail to: SJMC Run To Remember, PO Box 5464, Towson, MD 21285
Do not mail after September 5
Type Information, Print, and Sign Entry Form

Event: 5k   1 Mile Walk    I would like to volunteer
Entry Fees: $20 until Aug. 1 $25 until Sept 1 $30 if postmarked after Sept 1 - $35 Race Day (if race had not reached participant limit)

Deduct $5 if you are a law enforcement or fire agency employee or Baltimore City Team and note which one below:

Fire Agency Employee outside Baltimore City   Baltimore City Fire
Law Enforcement Agency outside Baltimore City Baltimore City Police
Member Baltimore City Team City Council President's Office Mayor's Office   State's Attorney's Office

First Name:   Last Name:
Address:
City:       State:        Zip:   -
Age on race day:           Sex: M F
Date of Birth:   / /    Shirt Size: S M LG XL XXL (extra $3).
Day Phone:   - - Evening Phone: - -
Email: ______________________________________________________________

Waiver/Release Must be Signed Before Mailing:

In consideration of the acceptance of my entry, I, for myself, my executors, administrators and assignees, hereby release and discharge St. Joseph Medical Center, the Race Director, Charm City Run, Mayor and City Council, Baltimore City, Baltimore Community Foundation, all other sponsors of all claims of damage, injury demands, and actions whatsoever in a manner arising from my participation in this athletic event. I attest and verify that I have full knowledge of the risks involved in this event and am physically fit and sufficiently trained to participate.

_________________________________________________________ __________
Signature (parent or guardian if under 18) Date