First Name
Last Name
Address
Apt #
City
Postal Code
E-mail
Telephone #
Sex Male       Female
Age on race day

Make cheques payable to Longboat Roadrunners. Your cancelled cheque is your receipt. Donations of $25 or more beyond the entry fee will be issued a tax receipt.
Entry fee (Pre-entry, $25; Race day, $30)
Extra meal tickets @ $5
Donation to the S.C. Cooper Sports Injury Clinic
TOTAL
 

Release, Waiver and Indemnity

In consideration of your accepting my entry, I, intending to be legally bound for myself, my heirs, executors and administrators, do hereby release and discharge Sunset Shuffle, Longboat Roadrunners, the City of Toronto, Metro Parks and Property, The Runners Shop and Steam Whistle Brewing from any and all liability arising from illness, injuries and damages I may suffer as a result of my participation in this event. I also understand and agree that any sponsor may sub¬sequently use for publicity and/or promotional purposes my name and/or pictures of me participating in this event.

 
Print Name Date

 

_________________________________________________
Signature.     If participant is under 18 years of age, parent or guarian must sign.

Make cheque payable to:  Longboat Roadrunners, 85 Bleecker Street, Unit 104 Toronto ON M4X 1X1