Name: 
      Address: 
         City: 
        State:    Zip: 
        Phone: 
Date of Birth:    Age on race date: 
       Gender: M F     Category: 10K Wheelchair Fun Run
   Shirt Size: S M L XL
Team Category: All-Male All-Female Mixed Intercollegiate
    Team Name: 
Champion Chip: I will be using my own ChampionChip in the race. Number:
Form of Payment: Check Money Order Visa/MasterCard

Visa/Mastercard #______________________Expiration Date__________ Total Amount Paid: _______

Name on Card___________________________Signature_______________________

Waiver Must Be Read and Signed Before Mailing:

I know that runnign in a road race is a potentially hazardous activity and that I should not enter and run 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 the run. I voluntarily assume all risks associated with running in this race and participating in any wards ceremony thereafter (collectively, the "Event"), including, but not limited to, falls, contact with other participants, the effects of the weather, incluing high heat and/or humidity, traffic, and the conditions of the road, all such risks being know and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my application, I hereby, for myself and anyone entitled to act on my behalf, voluntarily waive, release and covenant not to sue the organizers of the Sallie Mae 10K, SLM Holding Corporation and all of its subsidiaries, SFX Sports Group, Inc. (including any of its parent or subsidiary companies, directors, shareholders, employees, and affiliated companies), other management companies, sanctioning organizations, beneficiaries, and all other sponsors, their representatives and successors, (colelctively, the "Releasees") from all claims or liabilities of any kind arising out of my participation in the Event or carelessness on the part of any Releasees. Further, I grant permission to the Releasees to use for any legitimate purpose any photographs, motion pictures, recordings, or any other record of the Event containing my name, likeness or performance.

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

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