    			Mickey's "4" Road Race - Fun Walk

    			Presented by the North Medford Club

    NORTH MEDFORD CLUB        MICKEY'S PLACE          SEAN PATRICK'S

    A donation will be made to the Kevin Szocik Memorial Scholarship Fund

    Date: Sunday, August 31st, 2003 Race day registration begins at 11:00 rain or shine

    Time: Fun Walk 12:15 p.m.
          Run 1:00 p.m.

    Place:	MICKEY'S PLACE  494 Electric Avenue Lunenburg, MA  01462

    Entry-Fee	$12.00 Pre-registered  $15.00 after August 16th

    Course:   	4 miles.  A nice rolling course.  One water stop.   Mile markers.

    Timing/Scoring:	 North Medford Club

    Divisions: Open, Masters, Seniors & Veterans.   Male/ Female 3 deep in each division

    Amenities: Post race refreshments, T-shirts to entries received before August 16th

    Make Checks Payable to: North Medford Club
    Mail Entry To:
    Deb Fontaine
    786 Elm Street
    Leominster, Ma  01453

    For more information, contact Ken Parker
    E-mail  kparker@northmedfordclub.org
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    Name:   ______________________________________________________
    Address: _____________________________________________________
    City: _______________   State:___    Zip: __________
    Daytime Phone: ________________________          Date of Birth: _____________________
    Gender:  M   F       T-shirt Size:  M    LG     XL  (circle one)

    Waiver Must Be Read and Signed Before Mailing:
    I, for myself, my executors, administrators and assignees do hereby release and
    discharge all sponsors and race officials from all claims, damages and actions that
    may occur as a result of my participation in this event. I also grant permission to
    use my name, photos or videos of my participation for any legitimate purpose.

    _____________________________  _____________ /_________________Signature / Date