| ENTRY FORM |
Capitol |
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| Please enter me
in . . . (please check one) |
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Capitol
5000 (5K) - $16 by June 14 or $20
thereafter |
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1
mile Fun Run/Walk - $7 by
June 14 or $10
thereafter |
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1/3
Mile Kids Run for children under 7 years old -
$7 by June 14 or $10
thereafter |
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| Name: |
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Age |
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Sex |
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Birth Date: |
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| Street Address |
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City |
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Zip |
Telephone (with area code) |
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| Previous Best Time
minutes
seconds |
year |
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| I know
that running the 5K run, 1 Mile or the Kids run is a potential hazardous activity. I should
not enter and run unless I am medically able and properly trained. I
agree to abide by any decision of a race official relative to my ability
to safely complete the run. I assume all risks associated with
running the event including, but not limited to: falls, contact with other
participants, the effects of the weather, including high heat and/or
humidity and cold or slippery conditions of the race course, all such
risks being known and appreciated by me. Having read this waiver and
knowing these facts and in consideration of your accepting my application,
I for myself and anyone entitled to act on my behalf, waive and release
the race director, race officials and volunteers, any and all sponsors
including, but not limited to all their representatives and successors
from all claims or liabilities of any kind arising out of my participation
in this event. Waive and release to the I.O. Silver Games the right to use
photographs taken at this event. |
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| Signature |
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| Co-Signature (Parent/Guardian must cosign if applicant is
under 18 years of age) |
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Shirt Size
(subject to availability after June 14th)
please check one: |
Entry Fee: $
Additional Donation: $
Total amount
enclosed: $
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small |
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medium |
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Please
make check payable to I.O. Silver Games
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large |
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extra
large |
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Accommodations Available:
Comfort Inn Riverfront
Off I-83 at Exit 23
525 S. Front Street
Harrisburg, PA
(Rate: $70 per night, mention race when calling)
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Mail entry form and payment to:
I.O. Silver Games
431 Springhouse Road
Camp Hill, PA 17011
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