Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Runner's name

First Name

Last Name

Runner's DOB

MM

DD

YYYY

In consideration of this entry being accepted, I hereby waive and release any and all rights and claims to damage that I may have against the Borough of Glen Ridge, the Glen Ridge Community Fund, Mayfield Tavern Partners, LLC., aka Fitzgerald's 1928, race of- ficials, volunteers, and any employees and representatives, for any and all injuries that I may sustain in this event. I acknowledge that I have read this form and fully understand the terms that I am physically fit and sufficiently trained to participate in this event. I am at least 18 years of age or have had this release signed by a parent/guardian if I am under 18 *

Agree

i would like to volunteer to help with the Lager Run

yes