Registration Information:  (* = Required fields)  

        *Select Event:     5K Run        Health Walk      Lollipop Run

* First Name:
* Last Name:
* Sex:	Male Female
*Age:
*  Birthdate:
*StreetAddress:
*Apt #:
*  City:
*   State:
* ZIP Code:
* Telephone #:
* E-mail:
USATF #:
T-Shirt Size	Large XL 1X 2X

Please contact me as soon as possible regarding this matter.
 

Enter any special comments in the space provided below:

*WAIVER
I am medically able and properly trained to participate in this race.  In consideration of the acceptance of my application, I, my heirs, executor, administrator, successor and assigns do hereby acquit and forever discharge the County of Union, City of Plainfield, Department of Recreation, USATF-NJ, event sponsors, agents, and persons involved in the promoting of this race from any and all claims, causes of action, demands, rights, damages, costs, loss of  service, expenses and compensation which I may hereafter accrue of or in unforeseen damage and consequences resulting or to result from my participation in the Cardinal Cedarbrook Park Grand Prix Event-5K Run/Walk, held Saturday, May 5 2007 in Plainfield, NJ.  I also give my permission for the use of my name and/or picture in any newspaper, broadcast, telecast or other account of this event.
(type name to indicate signature)
 

          This form may be reproduced.  Please submit separate forms for each participant.