Manchester City Marathon, Half Marathon and Relay OFFICIAL ENTRY FORM Sunday, November 2, 2014 USATF New England Championship One person per entry form, this form may be duplicated Mail-in entry deadline for all events is 10/23/2014 No Refunds or Transfers BOTH PAGES MUST BE RETURNED First Name Last Name Gender (Circle) M Age on 11/03/13 DOB (Mo/Day/Year) F / Race (Circle) FULL / HALF RELAY Shirt Size (circle) FEMALE XS S M L XL Is this your first marathon/ half? YES / NO MALE S M L XL XXL Anticipated Time (circle) : Street Address City State Zip Code Email Address (will get race news and updates) Daytime Phone Evening Phone ( ) - Emergency Contact First Name ( ) - Emergency Contact Last Name Daytime Phone ( ) - Would you like a text message of your finishing time? YES NO (circle) If yes, please provide your cell phone number: ( ) - USATF – NEW ENGLAND MARATHON CHAMPIONSHIP www.usatfne.org THIS COURSE IS USATF CERTIFIED AND SANCTIONED Club Name 10 digit USATF number 3 digit club number Team scoring requirement and USATF – NE Grand Prix guidelines may be found at: www.usatfne.org/road/gp Review and sign waiver In consideration of this entry being accepted, I, for my heirs, executors, assigns, personal representatives, and administrators, waive and release any and all claims for personal injury and damages I may have against the organizers, City of Manchester, sponsors of this race, and volunteers. USATF, USATF New England and all of its officers and/or representatives shall be free from any liabilities or claims for damages arising by reason of injuries to anyone during this event. I attest and verify that I am physically fit and have sufficiently trained for this event. I freely and voluntarily accept responsibility for all risks including death, personal damages and injury, and personal property damage and loss that may occur prior to, during, and after this event. I voluntarily participate in this event in recognition of—and in spite of—all associated risks with running this event, including, but not limited to, falls, contact with other participants, the effects of weather, including cold, heat, and rain or snow; traffic and surface road conditions and human error by volunteers or race officials. I understand that roller skates or blades, bicycles, baby joggers, animals, and skateboards are prohibited from the race and I will abide by the guideline. Moreover, I understand that the Manchester City Marathon and those authorized by the Manchester City Marathon and Half Marathon will be taking photographs, and making audio and video recordings of the participants, races and related events. I hereby irrevocably consent to, and grant use of, all photographs and recordings, digital and otherwise that contain my person, image, likeness, or name and voice, for any lawful purpose including news reports and event promotions. SIGNATURE OF PARTICIPANT * * If under 18 years of age, parent or guardian signature is required DATE Only runners with current USATF membership prior to the start of the race are eligible to receive prize money. Foreign athletes must be eligible under IAAF and their home country federation’s rules to be eligible to receive prize money. To be eligible to score as an individual or as a member of a team in the USATF-NE Championship and to be scored as a Grand Prix Ironrunner, a runner must be a current USATF member in the New England Association as of the start of the race. Proof of current USATF membership must be submitted before the race by including their membership number on the entry form. All other entrants are encouraged to register with the USATF-NE or their local USATF Association. To register, contact the New England Association, USATF, P.O. Box 1905, Brookline, MA 02146, 617-5667600. You may also register on line at www.usatfne.org. A USATF-NE representative will be present at race headquarters on Saturday to register athletes. MAIL ENTRIES INCLUDING CHECK TO: MANCHESTER MARATHON ASSOCIATION P.O. BOX 933 MANCHESTER, NH, 03105 Entry Fee Enter By MARATHON HALF MARATHON RELAY July 31,2014 $75.00 $65.00 $160.00 HALF MARATHON RELAY $80.00 Sept 30, 2014 $85.00 $75.00 $160.00 $80.00 After Sept 30, 2014 $95.00 $85.00 $160.00 $80.00