You must fill out the entire form. It will not be sent unless all fields are filled in.
Name
Address
City State Zip
Phone
Age on race day Date of birth Sex
Clydesdale (male 190+) Filly (female 140+)
T-shirt size:
Name on the credit card you will be paying with:
In consideration of this entry being accepted, I hereby, for myself and my heirs, executors or administrators, waive and release all rights and claims for damages I may have against Murdick's Fudge of M.V., the Town of Tisbury and any and all sponsors for any and all injuries incurred before, during or after Murdick's 5 Mile Run the Chop Challenge.
Check box to signify that you agree to the above considerations.