MAGIC MOUNTAIN

5 MILE ROAD RACE/WALK

TO BENEFIT THE TIMOTHY E. LOUGHLIN SCHOLARSHIP FUND

SUNDAY, NOVEMBER 17, 2002


Registration begins @ 9:00 A.M.      Walk begins @ 10:00 A.M.      Race begins @ 11:00 A.M.

COST: $10. 00 Pre-registration before November 2       $12.00 Day of event

WHERE: Leominster Sportsmen's Club (Home of the former "Monty Mountain" road race) 1455 Elm Street, Leominster, MA

T-SHIRTS******PRIZES****** RAFFLE******REFRESHMENTS

Water stops & mile markers. Plenty of parking. Restrooms & Cash bar available.

TIMING & SCORING BY NORTH MEDFORD CLUB WWW.NORTHMEDFORDCLUB.ORG

TO PRE-REGISTER FOR THIS EVENT, PLEASE DETACH THIS SECTION AND MAIL WITH A CHECK PAYABLE TO: TIMOTHY E. LOUGHLIN SCHOLARSHIP FUND C/o BETTY & KEITH LOUGHLIN, 91 EXCHANGE STREET, LEOMINSTER, MA 01453 FOR INFORMATION CALL: BETTY OR KEITH @ 978 534-8904

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NAME___________________________________

STREET________________________________________

CITY, STATE, ZIP___________________________________________

PHONE_______________________ PLEASE CIRCLE: WALK / RUN - MALE / FEMALE AGE____

T- SHIRT SIZE: M______L_____XL______

I agree to assume all responsibility for all risk of damage or injury to me as a participant in this event. I hereby, for myself, my heirs, of action, present or future, whether the same be known, anticipated, or unanticipated, resulting from or arising out of, or in incident to, my participation in this event. I hereby certify that I am physically fit and sufficiently trained for this event. I understand that bicycles, skateboards, baby joggers or strollers, roller skates or blades, dogs, and radio headsets are not allowed in the race and I will abide by this guideline.

SIGNATURE ___________________________________________________________________________Date____________________ (Please have parent or guardian sign if participant is less than 18 years of age.)