To register, mail this form and check to
UNITED WE STAND
PO Box 25049
Arlington VA 22202

Name_________________________________

_________________________________________ 
Address

__________________________________________ 
City              State             ZIP 

Phone _______________ 

Age on 11/8 ____       M  |  F  


[_]	Enclosed is $18 before November 1	 
    or $20 after November 1                ���$  

[_]	Enclosed is an additional donation to
    FEDERATION 9/11 SCHOLARSHIP FUND       ���$  

[_]	Enclosed is an additional donation to 
    USO OF METROPOLITAN DC                  ���$

  _________________________________________

Discover|MC|Visa |_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_| 
Exp.Date |_|_|_|_|  Name ___________________[____]	


___I will help as a volunteer.  Please call me.   

I know that running a race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relevant to my ability to safely complete this event. I assume all risks associated with running in this event, including, but not limited to: falls, contact with other participants, effects of the weather, including high heat and/or humidity, and conditions of the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release all sponsors, including Arlington County VA, RacePacket, Arlington County Civic Federation, USO of Metropolitan DC, their officers, directors, agents, and employees, and all officials of this event from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I agree to release my name and photo for publicity purposes. I understand that my name and address will be provided to the sponsors of this event, including Runner's World and Running Times magazines. Parent or guardian must sign for children under 18.

Signature (Parent or Guardian of under 18)

Name ______________________________

Date _________________


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This page was last revised on: December 27, 2003.