The Staten Island Runner

Step1:
Personal Information
First Name
Last Name
Race Day Age
Male Female
Address 1
Address 2
City State Zip Code
Phone
Email Address
S M L XL XXLShirt Size
Race Division (must select one):
Open/Age Group NYC Firefighter Male Clydesdale 190+ lbs. Female Athena 140+ lbs
Firefighter Open Team Master Team NoneTeam Type
Team Name/Fire Department Co.#
By submitting this form I agree to the following:
In consideration of your accepting this entry, I the undersigned, intending to be legally bound, hereby for myself, my heirs, executors, and administrate, waive and release any and all rights and claims for damages I may have against the Susan E. Wagner & Al Ronaldson Committee & the City of New York and their representatives, successors, and assigns for any and all injuries suffered by me in said event. I attest and verify that I will participate in this event as a footrace event, that I am physically fit and have sufficiently trained for the completion of this event and my physical condition has been verified by a licensed Medical Doctor. Further, I hereby grant full permission to any and all of the foregoing to use any photographs, videotapes, motion pictures, recordings, or any other record of the event for any legitimate purpose.
There will be a $1.95 processing fee for online application.