NAME:______________________________________________________________
ADDRESS:__________________________________________________________
CITY, STATE, ZIP:____________________________________________________
PHONE:_________________________ T-SHIRT SIZE (circle): S M L XL
DATE OF BIRTH:_____________ AGE (on 4/5/08):_____ SEX (circle): M F
E-MAIL:_____________________________________________________________
WAIVER: WAIVER: In consideration of acceptance of this entry, I waiver any and all claims to myself and my heirs, executors, other legal representative and estate, against officials of Anniston Army Depot, other officials of the United States Government, and the United States Government itself, for injury or illness which may result directly or indirectly from my participation. I further state that I am in proper health and physical condition to participate in the event and that I am an amateur runner.
____________________________________________________________________ Fee is $12 early or $17 race day.
SIGNATURE (Parent or Guardian if under 18 years old) DATE
For military and students, fee is $5 early or $5 race day.
Make check payable to IMWRF and mail to:
IMWRF Anniston Army Depot
7 Frankford Avenue
Attn: Fitness Center Staff Bldg 205
Anniston AL 36201-4199
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