Please fill out this form completely and legibly (print!), and sign the waiver. Mail the form with your check payable to "Prostate Cancer Education Council" to: PACE Race 5K Run/Walk, 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 August 30 or fax after September 3!

____ I am a prostate cancer survivor.
____ I would like to volunteer, please contact me.
____ I am a ChampionChip owner, and I have deducted $2 from my 
     entry fee. My ChampionChip number is: _____________________ 
     (include full seven-character ID)


Name: __________________________________________________________


Address: _______________________________________________________ 


City: ___________________________ State: _______ Zip: __________


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


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


Choose your event:     5K Walk      5K Run   (circle one)


E-Mail Address: ________________________________________________


____ I am adding an additional contribution of $____ to my entry
     fee for the Prostate Cancer Education Council. 


Day Phone: (_____)_____________________


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


Fees:
Adults - $20 postmarked by August 30, $25 race day
Adults 60 and over, and children 18 and under - $10 postmarked 
         by August 30, $15 race day


Waiver:
I know that running 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 assume all risks associated with running 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 your 
accepting my entry, I, for myself and anyone entitled to act on 
my behalf, waive and release the organizers of the PACE Race 5K
Run/Walk, the Prostate Cancer Education Council, Capital Running
Company, and all other sponsors, their representatives and 
successors from all claims or liabilities of any kind arising 
out of my participation in this event or carelessness on the 
part of the persons named in this waiver. 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 also agree to return my rental 
ChampionChip or pay $35 for its replacement.


Signed:
________________________________________________________________ 
Parent or guardian if under 18 years of age           Date