December 2002 - January 2003 Edition

Sheri Adler First Day 5k Official Entry Form   Name        ______________________________________________   Street Address   _________________________________________   City, State, Zip    _________________________________________   Phone  ______  Date of Birth ________  Age: _____   Sex:  M / F   Event:   _______5K Run            _______5K Walk    T-Shirt Size:  __ S  __ M  __L   __ XL    In consideration of this entry being accepted, I hereby for Heirs, executors, administrators, and myself waive any claim that I may have against the Fair Lawn Sunrise Rotary, Fair Lawn News, Borough of Fair Lawn Volunteer Ambulance Corps, Fair Lawn Police Department or their representatives, successors, or assignees for any injuries that may be suffered by me in this event.  I do hereby certify that I am in physical condition for this event.    Signature:  ___________________________   Parent Signature (if under 18): ________________   Date:  _________________     Make check payable to Fair Lawn Sunrise Rotary and mail to: Peter Michelotti Community Bank of Bergen County 12-79 River Road Fair Lawn, NJ 07410   For more information, contact Peter Michelotti at 201-791-0101 or Kevin Budd at 201-796-7995.     Entry Fees Pre-registration: $12 ($10 for USATF Members) Day of Race: $16 ($14 for USATF Members) Children under 18: $8 $40 Maximum charge per family.