FAXON LAW FAIRFIELD ROAD RACE REGISTRATION

Early Bird / 11/11 - 1/17 / 1/17 - 2/14 / 2/15 - 3/31 / 4/1 - 6/1 / Raceday
(If Available)
Half Marathon / $50 / $55 / $60 / $65 / $70 / $75
Half Marathon
Student(18 & under) / $40 / $45 / $50 / $55 / $60 / $65
5K / $25 / $27 / $28 / $30 / $32 / $35
5K
Student(18 & under) / $15 / $17 / $18 / $20 / $25 / $30
Lucas Challenge:
5k & Half Marathon / $75 / $88 / $88 / $95 / $102 / $105
Lucas Challenge:
5k & Half Marathon
Student(18 & under) / $55 / $68 / $68 / $75 / $82 / $90
Kids Fun Run / $7 / $8 / $9 / $10 / $10 / $12

T-Shirt Size Unisex (Please Circle): XS S M L XL

Event: Half Marathon 5KLucas ChallengeKids Fun Run

If applicable:  Police Fire Department: ______

Mail my packet (if received by 5/1, additional $15):

Mail to:Fairfield Half Marathon Inc.

2 Buena Vista Road

Branford, CT06405

Last NameFirst Name

Address

CityStateZip

Age______MaleFemaleDate of Birth: / /

Email

WAIVER: I know that running a road race is potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I also know that, although police protection will be provided, there will be traffic on the course route. I 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 accepting my entry fee, I hereby, for myself, my heirs, executors, administrators or anyone else who might claim on my behalf, covenant not to sue, and waive, release, and discharge the Town of Fairfield, Town of Westport, The Fairfield Half Marathon Inc., Anthem Blue Cross and Blue Shield of Connecticut, John Bysiewicz, JB Sports LLC, the Fairfield Police Department, Westport Police Department, Race Officials, The Hole in the Wall Gang, employees, Volunteers, any and all sponsors including their agents, employees, assigns or anyone acting on their behalf, from any and all claims or liability for death, personal injury or property damage of any kind or nature whatsoever arising out of, or in the course of, my participation in this event. This Release and Waiver extends to all claims of every kind or nature whatsoever, foreseen and unforeseen, known and unknown. The undersigned further grants full permission to The Fairfield Half Marathon Inc. and/or agents authorized by them, to use any photographs, videotapes, motion pictures, recording, or any other record of this event for any purpose. Application for minors under 18 will be accepted only with a parent's signature.

Signature (Parent must sign if competitor is under 18 years of age)Date