| 2008 Ocean City Police Chase Race Entry Please Print and Send to Philadelphia Athletic Charities 611 Jamestown Street Phila. Pa 19128 Pick up your race number and T-shirt at the Ocean City HS Track on June 14, 6:30 to 7:50 am. Name______________________________________________ Address____________________________________________________________________ City_______________________ State___________ Zip_______________ Phone__________________________ Sex________ Age on Race Day______________ Shirt Size_______________ I am a Public Service Employee________(yes/no) For which Department_______________________________ Team Name_____________________________________ (if competing for Team Championship) Entry Fee : $15 up to 6/7/08. $20 after 6/7/08 Make Check to : Philadelphia Athletic Charities Send to 611 Jamestown St Phila Pa 19128 Waiver: I for myself, my heirs, and administrators, and executor waive and release all rights I have against the Ocean City Police Benevolent Assoc, OC Police Dept , Philadelphia Athletic Charities Inc, volunteers, sponsors and any association working with the Ocean City Police Chase.I waive all rights from injury i may receive at this event and I certify that I am in shape and have trained for this race and have been checked by a licensed physician. I issue permission to use my image for any future promotion of this event in print or video. Signature__________________________Date_______________ Signature of parent or gaurdian if participant is under 18 yrs old. |
