2nd Annual 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 29st, 2004 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 15th
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 15th
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