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To benefit the Southampton Rotary Scholarship Fund
Sunday, July 6, 2008 • 8:30 AM
Start and Finish at Southampton’s beautiful Agawam Park
8 Kilometers • 4.96 Miles
PRE-REGISTRATION FEE (before June 30) $20
ENTRY FEE DAY OF RACE $25 • Day-of-race registration 7:00-8:00 a.m.
Awards for standard age group categories
Free t-shirts for the first 350 to register
Clip and mail with your $20 check to: SOUTHAMPTON ROTARY CLUB PO BOX 1211, Southampton, NY 11969
NAME_____________________________________________________________________ AGE ON RACE DAY______ D.O.B_________
MAILING ADDRESS __________________________________________________________________________________________________
TOWN ____________________________________________________ STATE_____________________________ZIP__________________
AREA CODE AND PHONE ( _______ ) _______________________________________ MALE ______ FEMALE_______
E-MAIL ADDRESS ____________________________________________________
Clip and mail with your $20 check to: SOUTHAMPTON ROTARY CLUB PO BOX 1211, Southampton, NY 11969
Waiver: I know that running a road race is a potentially hazardous activity, and that I should not enter unless I am medically able and properly trained. I also know that although police protection will
be provided, there may be traffic along the course route. I will assume the risk of running in traffic. I also assume any and all other risks associated with running this event including but not limited to
falls, contact with other participants,
the effects of weather, including high heat and/or humidity, and the condition of the roads, all such risks being known and appreciated by me. Knowing these facts,
and in consideration of your acceptance of my entry fee, I hereby for myself, my heirs, executors, administrators and anyone else who might claim on my behalf, covenant not to sue, and waive, release,
and discharge any organization associated with the race, and the local governments and police, volunteers, and any and all sponsors including their agents. I hereby agree to release the Southampton
Rotary, the race director, the Village of Southampton, the police and all volunteers and sponsors from all claims for personal injuries or property damage, even if such injury or damage is caused by the
negligence of any of these parties. I agree that the Firecracker 8K Run officials have the right to remove me from the race and related activities if they are of the opinion that is my best interest that
I be removed, or if they are of the opinion that I have violated any USTF or IAAF rules. The undersigned further grants permission
for this race and any organization conducting the race, and/or agents
used by them, to use any photographs, videotapes, motion pictures, recordings, or any other record of this event for any purpose. I have read the foregoing and certify agreement by my signature below.
Signature_________________________________________Date______________________
For additional information or to download a
race application, visit our website:
www.firecracker8k.com
or call
631-283-6875
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