Smegs legs 2012 registration form
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Smegs legs 2012 registration form






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Smegs legs 2012 registration form Smegs legs 2012 registration form Document Transcript

  • 4th Annual Saturday October 6, 2012 9:00 AM – 12:00 PM Broad Meadows Middle School, Quincy 5 Mile Run / 2 Mile Walk Proceeds to benefit: Chris Smeglin, an Atherton Hough, Broad Access Sports America Meadows, BC High Alum, and graduate of the Houghs Neck Community Council Scholarship US Merchant Marine Academy in Kings Point, Broad Meadows Middle School Athletics NY, had an unquenchable zest for life, unique $20 Entrance Fee before 9/29/12 sense of humor and deep compassion for the needy. Online registration deadline 10/4/12 $25 Entrance Fee on day of the race After enlisting in the US Navy to fulfill a lifelong $10 Entrance Fee Students through grade 12 ambition to serve his country and become an Raffles and Silent auction aviator, Navy LTJG Chris Smeglin, a 24-year-old Houghs Neck, Quincy resident, was tragically T-Shirts to the 1st 350 registrants! killed on October 2, 2008 during a bike training Prizes for 1st, 2nd and 3rd place: session for a triathlon. DIVISIONS: Male, Female, Student, Clydesdale, Wheelchair, Military & Prize for Join us to remember Chris and continue his Best Costume cause at the 4th Annual Smegs Legs Run. Registration begins at 7:30 AM at Broad Meadows Middle School, 50 Calvin Road, Quincy, MA 02169 REGISTRATION FORM Full Name: ________________________________________ Please mail check along with registration form to: Address: _________________________________________ Chris Smeglin Memorial Fund City: ______________________ State: _____ Zip: ________ c/o Jane & Mike Smeglin 125 Spring Street Phone: ___________________________________________ Quincy, MA 02169 E-mail: ____________________________________________ * Checks payable to Chris Smeglin Memorial Fund. Size: S ___M ___L ___XL ___XXL___ Div: M ___F ___Student___Wheelchair___Clyde___Mil.___ ___5 Mile Run ___2 Mile Walk ___Donation DOB: _____/_____/_______ Age on race day: ________I hereby for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against the sponsors,coordinating groups and any individuals associated with the event, the representatives, assessors and assigns will hold them harmless for any and all injuriessuffered in connection with this event. I attest that I am physically fit to compete in this race. Further, I grant full permission to any and all of the foregoing to usemy photographs, videotapes, motion pictures, recordings or any other records of this event for any legitimate purpose.SIGNATURE: __________________________________________________________________DATE: ______________________________