Rockville Rotary Twilight Runfest
 

Printable Entry Form

This is NOT an online registration form.  To register online, go to the Online Registration page.  To use this form, you should fill in the required information, print the form and sign it. You should then enclose your check and mail it or bring it with you to packet pickup.
Please fill out the form completely. 

I am registering for:

8k (Early Registration - $22 )     Wheelchair Athlete
8k (After July 8 - $25 )
1k Fun Run ($10 - No T-Shirt)

Runner Information

First name
Last name
Street address
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
E-mail
Sex Male
Female		 Age: Date of Birth mm/dd/yy
ChampionChip No. (if you own one)
Which MD-RRCA Running Club?*
*For Maryland/RRCA Team Grand Prix

Amounts Enclosed:

Entry Fee:
Additional Contribution:
For Rockville Rotary Youth Recreation Fund
Total Enclosed:

Waiver

The following waiver must be read, understood, and agreed to by the runner. Failure to sign and date the waiver will result in the registration being rejected.

I know that running is a potentially hazardous activity and I should not enter unless I am medically able and properly trained. I assume all risks associated with running in this event including, but not limited to, falls, contact with other participants, the effects of weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. Typically, the conditions during this race are very hot and humid, and there is a danger of heat related injury or even death. I agree to abide by any decision of a race official relative to my ability to safely complete the run. Having read this waiver and knowing the facts and in consideration of your accepting my entry, I, for myself, and anyone entitled to act on by behalf, waive and release and indemnify the Montgomery County Road Runners Club Inc., the Mayor and Council of Rockville, City of Rockville, and all of its agents, officers, and employees, and the Rockville Rotary Club, and any sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event or carelessness on the part of the persons named in this waiver. No strollers, baby joggers, skates, pets, or headsets.

I have read and agree to the above waiver:  Yes No

Runner's Signature ____________________________________

Date: _________________

After completing this form, use your browser Print button to print the form. 
Be sure to sign and date it!

 If you need to start over, use this button to

bulletMake your check payable to: Rockville Rotary Club
bulletMail-In: Rockville Rotary Twilight Runfest, P.O. Box 4100, Rockville, MD 20849-4100

If you would like to pay by credit card, please register online at www.twilighter.org.
   
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Rockville Rotary
Twilight Runfest 2005