Print and send the application by October 31st to:

Race Committee/WMCAC
26 Howard St.
Springfield, Ma. 01105

Entry Fee: $20.00 Adult

                   $10.00 , ages 10 & under

Enclose check or money order payable to:
Family Sunshine Fund

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In consideration of the acceptance of the entry, I, hereby, for myself, my heirs, executors, and administrators waive release and any and all rights and claims for damages I may have against any and all of the above listed sponsors, and any and all associated parties, for any and all injuries suffered by me at this event. I attest and verify that I am physically fit and sufficiently trained to participate in this run/walk event.

Name:__________________________________________
Sex: _____ Male _____Female
Entry: _____ Runner _____ Walker _____ Donation
Sheriff’s Dept. Employee: _____ Yes _____ No
Address:_______________________________________
______________________________________________
City:__________________ Shirt Size:_______________
State:_____ Zip Code:___________ Age:_____________
Email Address:___________________________________
Signature:______________________________________
(Signature of Parent/Guardian if under 18):
_______________________________________________
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