ILION - AROUND TOWN

5 KM ROAD RACE

Saturday - July 24, 1999

ENTRY FORM

For More Information: Call - (315)894-2384

Please sign and return completed form to:

Ilion Days Committee
C/O Charles Maxson
190 East Main Street
Ilion, New York 13357

In consideration for allowing me to compete in the "Around Town 5 KM road Race," sponsored by the Ilion Park Board and Ilion Days Committee, I hereby waive any liability that the sponsors may have to me arising out of participation in this years race. Furthermore, I hereby agree to hold harmless the Ilion Park Board, Ilion Days Committee, and all sponsoring parties for any damage, either to me, my property, or equipment which may arise in relation to my participation in this race.

I am aware that participation in this race may present a serious strain to my body or its parts, and by my signature below, I attest that to the best of my knowledge, I am in good physical health and believe I am in condition to enter this event.

Signature:________________________________________

Date: ____________________________________________

Parent or Guardian must sign if participant is under 18 years

Signature of Parent or Guardian:________________________________________

Date:________________________________________

B A C K