Sunset Shuffle Entry Form

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, $20; Race day, $25)
Extra meal tickets @ $5
Donation
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