Run / Walk for Tara

Entry Form

 

 

 

Name:                                                                                                                                 

 

Street Address:                                                                                                                

 

City/State/Zip:                                                                                                                    

 

Phone:                                                                        (optional)

 

 

 

Please circle:    Runner / Walker

 

                                  Male / Female

 

 

      Please check one:

 

        $13.00 Early registration: Deadline November 4     $15.00 Day of race     $10.00 Student

 

      Optional additional donation to Tara Fund for Eating Disorders: $____

 

      T-shirt:   Yes     No 

 

 

 

      Signature ___________________________________________________

 

In signing this entry, I for myself, my heirs, executors and administrators, waive and release any and all claims for damages and liabilities in case of death or injury received during participation in the race that I may have against anyone sponsoring, sanctioning, or maintaining this race. If the runner is 18 or younger, this form must be signed by parent or guardian.

 

Through November 4, please mail this form and check payable to Tara Fund/CFWM to:

John and Maureen Sheehan
127 Pomeroy Meadow Road
Southampton, MA 01073

After November 4, please don't mail. Just bring form for race day registation.