Really Cool Half Marathon - Registration Form
Make checks payable to:	Delta Computer Solutions, Inc.
Print this form, fill it out and send to:	Really Cool Race that Doesn't Exist P.O. Box 123 Anytown, WI 53189

Name Address City, State, Zip Day Phone Evening Phone Email Address Age on 1/4/04 Sex   Select Event    ___  Half Marathon: 11:00am    ___  10K: 11:15am    ___  5K: 11:15am    ___  Kids Run: noon Select Age Division    5K    ___  14-19    ___  20-29    ___  30-39    ___  40-49    ___  50-59    ___  60-69    ___  70+    10K    ___  14-19    ___  20-29    ___  30-39    ___  40-49    ___  50-59    ___  60+    HM    ___  18-19    ___  20-24    ___  25-29    ___  30-34    ___  35-39    ___  40-44    ___  45-49    ___  50-54    ___  55-59    ___  60+     Circle Shirt Size    LSTS or T-Shirt:    Small      Medium      Large      X Large         Kids T-Shirt:    Youth Small      Youth Medium      Youth Large      In consideration of the acceptance of my entry, I, the undersigned, intending to be legally bound for myself, do hereby release any and all sponsors of this race, and their representatives, successors, and assigns, from any and all liability arising from illness or injuries I may suffer as a result of my participation in this race. I attest and verify that I am physically fit and have sufficiently trained for the completion of this race. I have read the forgoing and certify my agreement by my signature below.   Participant's signature Date   Guardian's signature, if participant is under 18 Date

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