5th Annual C.P.R.A Officer Chuck Martin Memorial 5K Race & Walk 

 

 

Thursday  August 19, 2010

 

 

5:45pm Fun Walk and 6:30 pm Race start- Registration begins at 4:30pm

Clinton Middle School Parking Lot- 100 West Boylston St.( rte. 110) Clinton Ma. 01510

Post Race Party, Awards and Prizes at the Clinton Lodge of Elks, 128 School St. Clinton

 

 

Step 1: Please Neatly fill in all information below.

 

Name:_________________________________________________________________

 

Address:_______________________________________________________________

 

City, State, Zip:__________________________________________________________

 

EMail Address:___________________________________________________________

 

Sex: M__  F__        Age (on August 19th 2010)_______

 

Running Club Affiliation:____________________________________________________

 

Law Enforcement Department:_______________________________________________

 

T-Shirts Size ( ALL Pre-Registered Applicants will receive an Official Event T-Shirt) S__ M__ L__ XL__ XXL__

 

Participating Event:  5K Run____    Fun Walk_____

 

Step 2: Review and Sign waiver

I hereby for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against the Clinton Police Relief Association, its affiliates, and subsidiaries, and their respective officers, directors, and employees, and sponsors, coordinating groups and any individuals associated with the Officer Chuck Martin Memorial Race, their representatives, successors and assigns, and will hold them harmless for any and all injuries suffered in connection with this event. I attest that I am physically fit to compete in this event. Further, I hereby grant full permission to any and all of the foregoing to use my likeness in all media including photographs, or any other record of this event for any legitimate purpose.

 

Signature ( A parent/guardian signature is required if entrant is under 18 years of age)_____________________________________________________________

 

Step 3: Send payment, Pre-Regsitration fee of $15.00 before Monday August 16th 2010 or $20.00 after that date, and completed application to:

 

Clinton Police Department

CPRA- Officer Martin Race

176 Chestnut St.

Clinton, Ma. 01510

 

Make checks payable to the Clinton Police Relief Association. All Entry Fees are Non-refundable