Enter participant Name:  FIRST  LAST:

SEX: = M; = F.   

AGE on race day (May 17, 2008):     

Clyde/Fillie categories:       = Clyde (males >190 lbs);       = Fillie (females >145 lbs) 

Enter participant mailing Street Address (apt #, etc): 

Enter City Enter State Enter ZIP

Enter particpant Phone    If participant will use your own CHIP - enter the #:

Will participant need special considerations, i.e. ADA? :  = Yes ; = No .

RACE ENTRY:   LATE FEE CHARGES NOW IN EFFECT ($30 12K;  $25 5K)

12K  OPEN and NH-Grand Prix:    =12K NH Grand Prix Team member  ($30/entry);     =12K OPEN Event. ($30entry) 

NH Grand Prix Team Captain Name:  Phone

5K OPEN and OPEN TEAMS :  =5K OPEN TEAM (per person) Event ($25/entry);     =5K OPEN Event. ($25/entry)

4-Person minimum teams - at least 1 female - age-sex scoring

Enter your 12K NH GP TEAM/CLUB NAME  or  5K OPEN TEAM/ CLUB  Name:

Any Questions?: Hotline: 603-714-5508

T-shirt size:  Small   Medium  Large   Extra Large

Entrant e-mail address: (so we may contact you for corrections/photos - not distributed!)

RELEASE and WAIVER:  Athletes who participate in this competition may be subject to formal drug testing in accordance with IAAF and/or USOC Protocol. Violators, pursuant to USATF regulation 10, will be penalized with a period of ineligibility as well as disqualification from the event.  Any substance taken by an athlete, including over-the-counter medication, is at his/her own risk. Call the Olympic Drug Reference Hotline:800-233-0393.   I know that participating in this race is a potentially hazardous activity.  I should not enter and run unless I am medically able and physically prepared.  I also know there may be traffic on the course route and I assume the risk of running in traffic.  I also assume any and all other risks associated with running in this event including, but not limited to, falls, contact with other runners, the effects of the weather, including heat and humidity, and conditions of the road, all such risks being known and appreciated by me.

ADA Accommodations:   Per USATF guidelines An individual may submit a request for an accommodation, due to an asserted disability, either to this event/race director or  to a USATF Committee. The request must be specific to this particular competition and to a specific event discipline or activity or access at the Bedford Rotary event. USATF will not grant "blanket" accommodation requests applicable to multiple competitions, activities or event disciplines. Accommodation request must be entered 4-6 weeks prior to the event.

Knowing these facts and in consideration of accepting my entry fee, I hereby for myself, my heirs, executors, administrators, and anyone else who might claim on my behalf, covenant not to sue, and waive, release and discharge USATF, the Rotary Club of Bedford, NH, all sponsors, race officials and volunteers, the town of Bedford, the Bedford schools, NH and the State of New Hampshire, including their agents, assignees or anyone acting on their behalf, from all claims of liability for death, personal  injury, loss of property or property damage, of any kind of nature, whatsoever, arising out of, or in, the course of my  participation in this event.  This RELEASE and WAIVER extends to all claims of any kind of nature, whatsoever, foreseen or unforeseen, known or unknown.  I, the undersigned grant full permission for any photographs, videotapes, motion pictures, or any other recording of this event for any purpose.  All fees are nonrefundable.

IMPORTANT:   DO YOU AGREE TO THE CONDITIONS OF THE WAIVER? 

= Yes ; = No .(if "No", sorry but we cannot accept your entry)

DONATION OPTIONS (Please consider rounding up your entry fee to  $25 or $30 to include these options): 

Rotary Foundation for International Projects (i.e. POLIO PLUS, others): $0 $1 $2 $3 $4 $5 round up to $20 round up to $25 round up to $30

Our local Bedford Rotary Club Projects and Scholarships:  $0 $1 $2 $3 $4 $5 round up to $20 round up to $25 round up to $30

REGISTRATION TOTAL :    $

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Local NH Residents:   Do you want to join our "Friends of Rotary"program?  = Yes; = No

Joining "Friends of Rotary" keeps you informed of our upcoming speakers, Club activities, and service programs.

We will not sell or distribute your e-mail or personal information.  It is held in confidence.