Race for a Soldier 1/2 Marathon Training Group 2012

First Name: _____________________________Last:______________________________

Address: ______________________________City___________________State:________

Phone:_______________________Email:____________________________________

       Circle one:   Female   /    Male         D.O.B:__________ age:_________ 

            T-shirt size (circle one) unisex fit    XS     S     M     L     XL

                    Amount $80.00       Total Charge:  $___________

I warrant that I am physically capable to participate in this training group event and have done proper training.  In consideration of my entry for myself, my debtors, administrators and assignees, I do hereby release and discharge any rights  and claims against Route 16 Running and Walking and any other individuals or groups involved with the running of this event or any or all injuries suffered by me at this event or while traveling to and from the event.

Signature: ________________________________Date ___________

Parent Signature if 18yr/under_________________________________Date____________

Feel free to mail in checks if you can stop by the store between now and June 23rd. Make checks payable to Momentum Coaching.         

Route 16       6745 Kimball Dr. Ste E      Gig Harbor, WA 98335