Please fill out this form completely and legibly (print!), and sign the waiver. Mail the form with your check payable to "Capitol Hill Classic" to: Capitol Hill Classic, 13710 Ashby Rd, Rockville, MD 20853-2903. Or, add your credit card number and expiration date, and fax the form to (301) 871-0006. Do not mail after May 9 or fax after May 14!

____ I am a ChampionChip owner, and I have deducted $2 from my 
     entry fee (10K/3K). My ChampionChip number is:_____________ 
     (include full seven-character ID)


____I would like to volunteer



Name: __________________________________________________________



Address: _______________________________________________________ 



City: ___________________________ State: _______ Zip: __________



Sex:  M   F  (circle one)        Age on Race Day: ______   



E-mail Address: ________________________________________________



Team Name: _____________________________________________________


Team entries: Please make sure that all of your team members write
the SAME team name on each entry form!



Event:  10K  3K  Fun Runs  10K Team



T-Shirt Size:     S     M      L     XL  (circle one)



Credit card: ____________________________________ Exp.__________ 
(Master Card or Visa) 



Daytime Phone: (_____)_____________________




Fees:
$20- 10K ($22 after April 30, $25 raceday)
$18-  3K ($20 raceday)
$10-  3K (Cluster School Students)
$10- Kids Fun Runs
Team entries follow the same guidelines as individual 10K registrants



Waiver:
In consideration of the foregoing, I, for myself, my heirs, 
executors, administrators, personal representatives, successors 
and assigns, waive and release any and all rights, claims and 
courses of action I have or may have against the Capitol Hill 
Classic 10K, its Primary Sponsor and its affiliates, their 
agents, employees, officers, directors, successors and assigns, 
Capital Running Company, Inc., and any and all sponsors, their 
representatives and successors, that may arise as a result of my 
participation in the Capitol Hill Classic and any pre- and post- 
event activities. I attest and verify that I am physically fit 
and have sufficiently trained for the completion of this event 
and my physical condition has been verified by a licensed 
medical doctor. Further, I hereby grant full permission to any 
and all of the foregoing to use any photographs, motion 
pictures, recordings, or any other record of this event for any 
legitimate purpose including commercial advertising. I also 
agree to return my rental ChampionChip or pay a $35 replacement 
fee.



Signed:


 
________________________________________________________________ 
Parent or guardian if under 18 years of age           Date