2007 ADK STRIDE FOR PRIDE REGISTRATION FORM

September 23, 2007 Adirondack Stride for Pride Registration
(One Form per Runner, Please)

First 75 pre-registered runners for 5k/10k and first 25 for Fun Run wil receive t-shirt. T-shirts will be for sale on race day.

Mail entries to: Adirondack Pride Inc.
PO Box 694
Saranac Lake, NY 12983


Name:___________________________________________________________

Address:_____________________________________________________________________

Email: _____________________________

Registering for: (until/postmarked 9-13 / after 9-16)
_____ 5K ----($15.00/20.00) _________
_____ 10K ---($15.00/20.00) _________
_____ Fun Run -($9.00/12.00) _________


Additional Donation: ________________

Total Amount Enclosed: ________________

Birthdate:__________Age:_____Sex:______

T-shirt size: Child’s L Adult S M L XL

Physically Challenged Division (if applicable):
______ Wheelchair _____ Ambulatory


Make Checks Payable to: Adirondack Pride Inc.

I agree to participate in the Adirondack Stride for Pride 5K/10K Roadrace. In consideration of my entry, I do hereby waive, release and forever discharge any and all rights and claims which I (or my child) may have or which hereafter accrue to me against the sponsors or the officials conducting the run, for any and all injuries suffered by me (or my child) while participating in the event and do further certify that I (or my child) am physically able to participate in this event.

___________________________________________________________________________________________
Runner’s Signature Required Date (Parent’s Signature Required for Runners under 18)