ZOOM thru ZULU

ZOOM thru ZULU Registration

On Line Registration

or print this form, enclose entry fees payable to "Race Event Trust Account"and mail to:

ZOOM thru ZULU
c/o Mitch Harper
5207 Hopkinton Dr,
Fort Wayne IN 46814

Home Race Information Course Registration Results Links Name: _____________________________Age on race day: _______

Address:____________________________________________

City: _____________________ State: __________ Zip:_______

Phone: ________________ Sex: M ( ) F ( ) T-Shirt size: ( ) M ( ) L ( ) XL

Entry Fees:
Event (circle applicable items) Postmarked before Oct. 3 Postmarked after Oct. 3
10K Run /10K Relay / 5K Walk $6.00 8.00
Kid's Fun Run 2.00 2.00
Short sleeve T-Shirt (indicate size _____ ) 9.00 9.00
Long sleeve T-Shirt (indicate size _____ ) 14.00 ----
Total Enclosed _______ _______

LIABILITY WAIVER:
I know that running a road race is a potentially hazardous activity. I should not enter and run or walk this event 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 this event. I assume all risks associated with running or walking in this event including, but not limited to: falls, contact with other participants, the effects of weather, including high heat and/or humidity or lightning, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. For my safety, I understand that bicycles, skateboards, baby joggers, roller skates or in-line skates, animals, and radio headsets are not allowed in the race and I will abide by this guideline. Having read this waiver, and knowing these facts, and in consideration of your accepting my entry in this race, I, for myself and anyone entitled to act on my behalf, waive and release the Fort Wayne Track Club, all race officials and volunteers, all sponsors, the Fort Wayne-South Bend Diocese, St. Louis Catholic Church, St. Louis Academy, and all their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event though liability may arise out of negligence or carelessness on the part of the persons named in this waiver.

_______________________________________________________________________  
Signature Date
_______________________________________________________________________
Parent Signature if under 18 yrs. Date
Fort Wayne Track Club
Ft. Wayne Track Club
Home Race Info Course Registration
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last revised 9-26-2004 dsw .