BayState Marathon

First:___________________    Last Name:______________________

Address:_________________________________________________

City/Town________________________     

State:________        Zip:__________

Sex:_________        Age (on 10/19):________  

Club:____________________________________________________     

Marathon ______        Half______       

Entry Fees:

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Marathon:
$55 received by 10/1, $65 10/1-10/18, $75 race day

   
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Half:
$35 received by 10/1, $45 10/1-10/18, $55 race day

Make checks payable to BayState Marathon

Total enclosed: ________

Mail to:  BayState Marathon
               Marx Running & Fitness Center
               423C Great Road
               Acton, MA 01720

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In consideration for this race entry being accepted, I hereby for myself, heirs, executors, administrators waive and release any and all rights and claim for damages I may have against the City of Lowell, the race directors, The Greater Lowell Roadrunners, all sponsors and any others associated with this race for any and all injuries suffered by me before, during, or after this event.

Signature: (Parent if under 18)

 

__________________________ Date__________

Official Use