Name: 
      Address: 
         City: 
        State:    Zip: 
        Phone: 
       E-Mail: 
Date of Birth:    Age on race date: 
       Gender: M F
        Event: 5K 2.5K Walk
    Entry Fee:  $12  $18 After 5/14
 T Shirt Size: S M L XL  
                Please send me more information about programs at the Synagogue
               Here is an additional donation for the Scholarship Program $ ______
               Your donation to the MEN'S CLUB, ARLINGTON-FAIRFAX JEWISH CONGREGATION is tax-deductible under §501(c)3.
               I will help as a volunteer. Please call me. Every volunteer gets a t-shirt and the post-race picnic.

Waiver Must Be Read and Signed Before Mailing:

I agree to waive any and all claims I may have against all sponsors and all officials of this event for any damages or injuries I may suffer en route to, during, or as a result of my participation in this event. I affirm that my physical condition and fitness are adequate for me to participate safely in this event. I agree to release my name and photo for publicity purposes.

_______________________________  _____________ _____________________________________
Signature                        Date          Parent's Signature if under 18