Western Mass Athletic Club

Monroe Dunbar Brook Trail Races Entry Form

10 a.m. Sunday October 10, 2010

[ Race Description ] |  [ Race Directions ] |  [ WMAC Home ]

Pre-register before 10/1/10: $12 for 10.5 mi, $8 for 2 mi.
Please send entry form(s) with a check for the fee made out to:
WMAC, P.O. Box 356, Adams, MA 01220

Please circle which Monroe Trail Race you are entering:  2 mile  or   10.5 mile

PLEASE PRINT CLEARLY
Name ____________________________________

Street ____________________________________

Town __________________________State _____

Zip __________ Phone ______________________

email _____________________________________

Age ______ Sex:   M / F
OFFICIAL USE ONLY

BIB #_______________

Entry fee $_____
Total $_____
WMAC member Yes  No



Please enter me in the indicated Monroe Dunbar Brook Trail Race. I agree to assume all responsibility for and all risk of damage or injury that may occur to me as a participant in this event. In consideration of being accepted as a participant in this event, I hereby, for myself, my heirs, executors and administrators, release and discharge any and all sponsors of the Monroe Dunbar Brook Trail Races from all claims, damages, rights of action, present or future whether from the arising of, or incident to my participation in this event. I hereby certify that I am physically fit and have successfully trained for competition in this event. I also grant permission for the use of my name and/or picture in any broadcast, photograph or other account of this event.

Signature ___________________________________________________

Parent/Guardian (if under 18) _____________________________________