The Friendly Massey Marathon
P.O. Box 121, Massey, Ontario P0P 1P0
Phone: 705-865-2519
Fax: 705-865-2376
www.masseymarathon.com
Sunday July 16, 2017
Registration Form Boston Marathon Qualifier
Runner Information
Name: Age on Race Day: DOB:(MDY)
⃝ Male ⃝ Female ORA#:
Street Name: City:
Prov/State: Postal/Zip Code:
Phone#: Email Address:
Race Information
Race: Full Marathon ⃝ Half Marathon ⃝ Chutes 10km ⃝ Family 5km ⃝
Clydesdale: ⃝ (Male over 200lbs or Female over 150lbs)
***** No switching of race choice after the close of registration at Saturday 6:00pm*****
Have you ever competed in this event before? Yes No How many Times?
May we use your name in the event conformation list? Yes No
T-SHIRT SIZE: Mens: S MED LG X-LG XX-LG (PLEASE CIRCLE SHIRT SIZE)
Ladies: S MED LG X-LG XX-LG (PLEASE CIRCLE SHIRT SIZE)
Would you be interested in a draw for a camping site at Chutes Provincial Park?
Spaghetti Supper: July 15th Tickets Needed: ($8/person over 16, 5 & under free)
RELEASE, WAIVER AND INDEMNITY
IN CONSIDERATION of my being permitted to participate in the annual FRIENDLY MASSEY MARATHON races, I HEREBY RELEASE, WAIVE AND FOREVER DISCHARGE, the Township of the Sables-Spanish Rivers, The FMM committee members and volunteers, the ORA, the OTFA, and all sponsoring persons and their representatives from all claims or actions arising from my participation in the said event. I also warrant that I am physically fit to participate in this event.
I the undersigned have read and undersigned this form and its contents
Signature Print Name
Runners under 18 must have parent or guardian’s signature
Parent Guardian Signature Print Name
Event Fee Schedule
Postmarked by June 1st Full & Half Marathons $65 Chutes 10k $40 Family 5K $30
Postmarked by June 30th Full & Half Marathons $70 Chutes 10k $45 Family 5K $35
After June 30th Full & Half Marathons $75 Chutes 10k $50 Family 5K $40
AMOUNT ENCLOSED: Race Fee: $ Spaghetti Feast Tickets: $