Montville Lions 5K Run/Walk
Camp Oakdale Large Pavilion, 75 Oxoboxo Dam Rd. Oakdale 06370
May 3, 2015 (8:00 a.m. Registration - 9:00 a.m. Start)
Awards Following the Race at the Large Pavilion
SNERRO will be officiating
with chrono timing, splits
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Registration: (Please Circle: Activity, Gender, Bracket, Shirt Size)
Activity: Running Walking
Gender: Male Female
Bracket: Junior (14-under) High School (15-18)
Open (19-29) Sub Master (30-39)
Master (40-49) Grand Master (50-59)
Veteran (60-69) OMG YCSR (70+)
Shirt: Small Medium Large X-Large 2X-Large
Register by April 15th to guarantee a shirt
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Fee: $20 ($25 day of race); 15 and under $10 ($15 day of race)
Name: __________________________________ BIB#_____________
Address: ________________________________ Payment, info, and shirt orders go to:
City/St/Zip: ______________________________ http://e-clubhouse.org/sites/montvillect
Phone: _____________________ Age: ________ Facebook or mail to: Montville Lions
E-mail: __________________________________ P. O. Box 18
Signature: _______________________________ Uncasville, CT 06382
Parent or Guardian if under 18___________________________________________
Waiver: I know that running a road race is a potentially hazardous activity. I should not enter unless I am medically able and properly trained. I assume all risks associated with running this event. Having read this waiver and knowing these facts and in consideration of your accepting my entry fee, I, for myself and anyone entitled to act on my behalf, waive and release the Montville Lions Club, the Town of Montville, SNERRO, and all sponsors, their representatives and successors, for all claims or liabilities of any kind arising out of my participation in this event. Additionally, I grant permission to the Race Director to use or authorize the use of any photo, motion picture or video recordings of this event for any legitimate purpose. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident or illness, prior, during or after the race resulting from my participation in the event.