Road Race Application- Community Challenge

Where: When: Pre-entry

:

Montville Polish Club, 85 Maple Ave, Uncasville, CT June 2, 2013 (9:00 a.m. Registration 10:00 a.m. Start) Pre-entries by 05/22/2013 will receive a T-shirt, No Guarantees after that date.

Awards: Picnic: Officiating: Course:

Following the Race at the Polish Club Picnic area, around back. Picnic to start at 11:00 AM … All are welcome. SNERRO with chrono mix timing, splits Challenging course with ‘heartbreak hill’ on the return.

Race Directors: CHRIS OUELLETTE, SHAUN TINE, KATHY FOTTA, LINDA LINDA, MARNI OUELLETTE __________________________________________________________________________________________________________ APPLICATION DATA: (PLEASE CIRCLE ONE) I WILL BE: GENDER: WALKING MALE RUNNING FEMALE

AGE BRACKET: Junior (14 – under) High School (15 – 18) Open (19 – 29) SubMaster (30 – 39) Master (40 – 49) Grand Master (50 – 59) Veteran (60 – 69) OMG YCSR (70 ++) SHIRT SIZE: SMALL MED LARGE X-LARGE 2X-LARGE

MAIL ENTRIES TO:

MONTVILLE LION’S PO BOX 18 UNCASVILLE, CT 06382 Chris Ouellette at 860-334-4530 or 860-848-9893 Shaun Tine at 860-917-9474 or 860-848-3616

QUESTIONS? CALL:

PLEASE MAKE CHECKS PAYABLE TO:

MONTVILLE LIONS CLUB BIB #_______________

RACE ENTRY FEE: $20.00 ($25.00 on race day)
NAME: ADDRESS: CITY/ST/ZIP: PHONE: AGE:

EMAIL: ______________________________________
SIGNATURE: ___
In conjunction of your accepting this entry. I intend to be legally bound for myself, my heirs, executors and administrators waive and release any and all rights and claims of damages I may have against the town of Montville, all sponsors, S.N.E.R.R.O. and volunteers, for any injuries suffered by me at said event.

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