SOUTHERN CALIFORNIA ROADRUNNERS OF WALNUT
Invite you to race at Mt. SAC at the end of summer!

AUGUST 29, 2004
8:00 AM

REGISTER BEFORE 8/20/04 $17.00
AFTER 8/20/03 $20.00
CHILDREN 8 & UNDER $10.00
WOMEN’S RACE 8:00 AM
MEN’S RACE 8:30 AM
CHILDREN’S FUN RUN 9:00 AM

Race will be on the Cross Country Course at Mt. SAC College: Thomas Guide LA Pg. 639-G4

MAKE CHECKS PAYABLE TO:
SOUTHERN CALIFORNIA
ROADRUNNERS OF WALNUT, INC.

MAIL COMPLETED ENTRY FORM AND FEE TO:
SOUTHERN CALIF. ROADRUNNERS
C/O RITA HOGAN,
3906 TURQUOISE LANE
LA VERNE, CA 91750

Or Register ONLINE at http://www.active.com/event_detail.cfm?event_id=1140611

AWARDS 3 DEEP IN EACH DIVISION
OVERALL MALE & FEMALE WINNERS
WIN A PAIR OF SHOES FROM TOP SPEED RUNNING STORE OF LA VERNE, CA

For more information, call

(626) 622-8569 or (626) 347-8728

First Name: __________________________ Last Name ______________________________

(Please Print) Address: ___________________________________________

Phone: (____) __________________________________

City _________________________________ State: _________ Zip: ______________ T Shirt Size: S M L XL XXL

Female ¨ Male ¨ Age on Race Date: _________ Amount Enclosed: ____________

9 and Under ¨ 10–14 ¨ 15-19 ¨ 20-24 ¨ 25-29 ¨

30-34 ¨ 35-39 ¨ 40-44 ¨ 45-49 ¨ 50-54 ¨

55-59 ¨ 60-64 ¨ 65-69 ¨ 70 and over ¨

Waiver: In consideration of your accepting my entry, I the undersigned, intending to legally bind myself and my heirs, executors, administrators, next of kin and assignees, do hereby waive any and all rights and claims against any person or organization affiliated with this race. I agree to indemnify and hold harmless the SOUTHERN CALIFORNIA ROAD RUNNERS OF WALNUT, officials, the race organizers and any and all sponsors from any claims, actions, damages, liability and expenses, including attorney’s fees, on account of injury to my person or property or resulting in my death while I am competing, observing or participating in any way in this event, including travel to and from the race. I further attest that I am physically fit and have been sufficiently trained for the race that I am entering and that my physical condition has been verified by a licensed medical doctor.

__________________     ___________________________       ___________________________

Signature                              Parent Signature if Participant                                      Date

                                                           is Under 18