Print and send the application and check, payable to Canterbury Fair, to:
Road Race, PO Box 20, Canterbury, NH 03224.
E-mail contact: Brian Collins (bcollins@bhdssc.org)

Come join us for the 15th Annual

Canterbury Woodchuck Classic 5K Road Race
and Chipmunk Scramble 1.2 mile FUN RUN

Saturday, July 25, 2009

APPLICATION (enter one person per application form; make copies if necessary):

Name:
_______________________________________________________

Address:_______________________________________________________
City:____________________________________________________
State:___________________________________________________
Zip Code: _______________________________________________

Age (On Race Day): ____ Date of Birth: ____/____/____ Gender: M___ F___

___ Check here for Canterbury Woodchuck Classic 5K

The Canterbury Woodchuck Classic is a 5K Road Race covering a scenic route
through the center of Canterbury, New Hampshire.

· Fee: $15.00
· Raffle for all 5K competitors
· Prizes awarded to first 3 finishers in each age group, male and female:
19 and under, 20-29, 30-39, 40-49, 50-59, 60 and over
· Entry fee for 5K includes the choice of a free Woodchuck Classic T-shirt or one pint of Canterbury produced maple syrup for entries received by July 16, 2008.

Check one: ____T-shirt (Circle Size: S M L XL) ____ Pint of Maple Syrup

___ Check here for Chipmunk Scramble Fun Run

The Chipmunk Scramble is a 1.2 mile fun run for kids of all ages.
bullet Fee: $1.00
bullet All registrants receive a ribbon for completing the race

Both races begin at the Canterbury Elementary School at 9 AM. Water and refreshments will be provided to all runners.

Additional T-shirts and maple syrup may also be purchased:

T-shirts @ $9.00: #____ Size: S M L XL = $_________

Pint of Maple Syrup @ $8.00: #____ = $_________

Total Payment Enclosed (check payable to Canterbury Fair) = $_________

Waiver: In considering the foregoing, I, for myself and my heirs my executors and administrators, waive and release any and all rights and claims for damages I have against the Canterbury United Church of Christ, the Canterbury Fair, the Town of Canterbury, the race committee, and any and all sponsors, their representatives and successors as a result of my participation in the 2009 Canterbury Woodchuck Classic 5K/Chipmunk Scramble and any pre and post-race activities. I attest and verify that I am physically fit and have sufficiently trained for the completion of this event and a licensed medical doctor has verified my physical condition. Further, I hereby grant full permission to any and all of the foregoing to use photographs, videotaping, or any other record of this event for any legitimate purpose.

______________________________________________________
Signature
______________________________________________________
Signature of parent or legal guardian for runners under the age of 18