Baltimore Marathon Charity Registration Form

Homeless Persons Representation Project, Inc.
Due On or Before June 30, 2011 Races on October 15, 2011 Runner Information Name (First, Last, Middle Initial):____________________________________ Address: ____________________________________________________ City, State, Zip: ________________________________________________ Phone: _________________________ Date of Birth: _________________ Email Address: ________________________________________________ Emergency Contact (Name & Phone): _______________________________ Relay Team Information Please list below the names (including middle initial) of additional team members. Each member must also submit a separate application form. Name 1:_____________________________________________________ Name 2:_____________________________________________________ Name 3:_____________________________________________________ Team Name: __________________________________________________ Team Type: Shirt Size: Mixed XXL XL Male L Female M S
Under Armour shirts will be gender specific.

For Runners Supporting

Select a Race Marathon Adult ($110) Student ($100) Half-Marathon Adult ($100) Student ($90) Team Relay Adult ($320) Student ($280) 5K Adult ($60) Student ($50)
Register by July 1 and a portion of registration fee will benefit HPRP.

Wheelchair Athletes Crank Rim

Wheelchair Division offered only in the Full Marathon Distance.

Past Participant ‘06 ‘01 ‘07 ‘02 ‘08 ‘03 ‘09 ‘04 ‘10 ‘05 First Time Participant

Carbo-Load Dinner ($15/Runner) $_________ Receive a $20 gift certificate to Phillips Seafood Total Amount Enclosed $_________
Check Payable to HPRP Fee Paid Online

Restaurant or to any participating Little Italy Restaurant location.

Waiver: I know that running is a potentially hazardous activity. I should not enter and run unless I am physically fit, medically able and properly trained. I agree to abide by any decsion of a race official relative to my ability to safely complete the run. I hereby certify I am in good health, and I have trained to run the distance of the race of which I am entering. I assume all risks associated with running in this event, all risks being known and appreciated by me. Having read this waiver and knowing these facts and in considering your accepting my entry into this running event, I, for myself and anyone entitled to act on my behalf waive and release the Homeless Persons Representation Project, Inc., Corrigan Sports Enterprises, the Finished Product, Maryland Stadium Authority, their officials, directors, agents, volunteers, and employees, Baltimore City, Mayor and City Council, Department of Public Works, Recreation and Parks of Baltimore City, all sponsors, their representatives and successors, from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons or entities named in this waiver. I grant permission to all the foregoing to use my photographs, motion pictures, recordings, videos, or any other recording of this event for legitimate purpose. I understand that bicycles, skateboards, baby joggers, rollerskates or inline skates, animals and musical devices of any type are not allowed in this event and I will abide by this rule. Signature: ____________________________________________ Date:_____________________ (Parent signature required if partcipant is under 18) Homeless Persons Representation Project, Inc. (HPRP) is a non-profit 501(c)(3) tax-exempt organization. Contributions are tax deductible to the extent permitted by law. A copy of our current financial statement is available upon request by contacting HPRP at 1800 N. Charles St., Suite 206, Baltimore, MD 21201, 410-685-6589. Documents and other information submitted to the State of Maryland under the Maryland Charitable Solicitations Act are available from the Office of the Secretary of State, State House, Annapolis, MD 21401, for the cost of copying and postage.

Fax to 410-625-0361, Email to MDwertman@hprplaw.org or Mail to HPRP, 1800 N. Charles St., Ste. 206, Baltimore, MD 21201 Questions? Call 410-685-6589 x24

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