Crotched Mountain > News/Events > Newsroom > Brain Injury Awareness Day

Participating In:		5K	Entry Fee: $10.00 before 9/9/06 and $15.00 after 9/9/06
		Fun Walk

* Registration fee is waved if you raise $15.00 or more in pledges for the 5K and $10.00 for the Fun Walk.

Name:

Address:

City:

State:

Zip:

Phone:

Age:

Sex:

Free T-shirt to all registrants

Waiver: In consideration of my entry being accepted and the grant of permission of participation in the above named race, I for myself, my heirs, executors, administrators, and assigns, do hereby and with full knowledge of the consequences for this act, waive and release any and all rights and claims for personal injury or other loss or damage which may arise from said entry and/or participation in this race, against any and all sponsors, backers, supporters, and contributors to this race, including but not limited to Crotched Mountain Rehabilitation, the race directors, organizers, administrators, officials, and volunteers, and the business sponsors and promoters of this race.

Signature:_______________________________

Parent's Signature if under 18:___________________________________

Make check payable to: CMRC BIA Day

Mail To:

Brain Injury Awareness Day

Crotched Mountain

1 Gilbert Verney Drive

Greenfield, NH 03458