Spring Marathon Training Program Registration Form

2013 Spring Marathon Training Program Registration Form

Make checks payable to:
Lake Run Club

Send to:
Michael Fazio
305 S. East Street
Bloomington, IL 61701

More Information:
Michael Fazio
Ph: (309) 261-6186

Instructions on How to Register:
Print and complete this form. Mail it with your check to the address shown on the left.

Please complete All of the following:
Name:
Street Address:
City:
State:
Zip Code:
Email:
Sex:	M F
Phone:	--
Date of Birth:	- - (mm-dd-yy)
Target Marathon:
# of marathons run:	Goal time for this marathon:

Non-member Program Fee (non-refundable):
$55.00 -- Includes LRC membership, speakers, sport drink and LRC singlet. This is a great opportunity to consider joining the Lake Run Club. See more about the benefits of being a Lake Run Club member.

LRC Member Program Fee (non-refundable):
$45.00 -- Includes speakers, sport drink and LRC singlet.

No shirt option:
Subtract $10 -- If you do not want the LRC singlet.

LRC Marathon training shirt (Select one size if purchasing a shirt):
Size:	S	M	L	XL	XXL

In consideration of the foregoing, I for myself, my executors, administrators and assignees, do hereby release and discharge the Lake Run Club and other sponsors and supporters for all claims and damages, demands, actions, whatever in any manner arising or growing out of my participation in the Marathon Training Program. I attest and verify that I have full knowledge of risk involved in this event and I am physically fit and trained to participate in this event.


Signature (Parent if under 18)	Date