Please fill out this form completely and legibly (print!), and sign the waiver. Mail the form with your check payable to "City of Hyattsville" to: Outback Steakhouse 8K Run, 13710 Ashby Rd, Rockville, MD 20853-2903. Or, add your credit card number and expiration date, and fax the form to our office at (301) 871-0006.
Please do not mail the form after November 14 or fax after November 20!

_____ I would like to volunteer.  Please have someone 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   Age on Race Day: ______    Event:  8K    Fun Walk



E-Mail Address: ________________________________________________



Team name: _____________________________________________________



Day Phone: (_____)_____________________



Credit card:____________________________________ Exp. __________ 
(MasterCard or Visa)



I am including an additional donation of $______ for the Special 
Olympics of Prince George's County.



Fees:
$15 if postmarked by October 3
$20 from October 4 to November 14
$25 after November 14
$30 on race day
Teams: $15, team must consist of 5 or more runners (must 
be postmarked by November 14)



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 Outback 
Steakhouse 8K Run, Outback Steakhouse, Special Olympics of Prince
George's County, Capital Running Company, USATF, 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