Name: 
       Address: 
          City: 
         State:    Zip: 
         Phone: 
        E-Mail: 
  Today's Date: 
 Date of Birth:    Age on race date: 
        Gender: M F  
         Event: 10K 
    Shirt Size: M L XL 
     Entry Fee: $25 Individual before 9/15 $30 Individual after 9/15
                $25 Team before 9/15       $30 Team after 9/15
     Team Name: 
  Team Captain: 
 
 

 LIABILITY WAIVER MUST BE READ AND SIGNED BEFORE MAILING
 I know that running/walking a road race is a potentially hazardous activity and that 
 I should not enter and run/walk unless I am medically able and properly trained. I agree
 to abide by any decisions of a race official relative to my ability to safely complete 
 the run/walk. I assume all risks associated with running/walking in this event including, 
 but not limited to: falls, contact with other participants, the effects of the weather, 
 including high heat and/ or humidity, traffic and the conditions of the road, all such 
 risks being known and appreciated by me. Having read this waiver and knowing these facts
 and in consideration of our accepting my entry, I, for myself and anyone entitled to act 
 on my behalf, waive and release the organizers of the Rediscovery 10K, the National 
 Rehabilitation & Rediscovery Foundation, DC Road Runners Club, and all other sponsors, 
 their representatives and the persons named in this waiver. I understand that if I do 
 not participate in this race or if this race cannot be held by act of God or circumstances 
 beyond the Rediscovery 10K control, any expenses incurred or entry fees paid by me to 
 participate will not be refunded. Further, I grant permission to all of the foregoing 
 to use any photographs, motion pictures, recordings, or any other record of this event 
 for legitimate purposes. 
 
 I have read the above conditions and accept them as shown by my signature below.
 
 _________________________________                      _______________________________
 Signature (Parent/Guardian if under 18 years of age)    Date