2017 Groton Road Race
Sun Apr 30, 2017
2K Fun Run:10:45 am$28.00 Discounts for youths and seniors will be applied at checkout time.
Tots Trot (Age 0-6):10:45 am$8.00
5K:10:45 am$28.00 Discounts for youths and seniors will be applied at checkout time.
10K:10:45 am$28.00 Discounts for youths and seniors will be applied at checkout time.
BIB #

(text to be included at the top of the paper application)

Note: Lines 1-4 are mandatory. You cannot be entered into the race if they are not complete and legible.
1First Name 
2Last Name 
3Gender   MALE      FEMALE      (please circle one)
4Age(your age on race day)

5Birthday 
6Address 
7  
8City 
9State 
10Zipcode 
11Phone 
12Email 
13Race T-Shirt
Shirt Size
Male SmallMale MediumMale LargeMale X-Large
Female SmallFemale MediumFemale LargeFemale X-Large
Youth Small (cotton)Youth Medium (cotton)Youth Large (cotton)
14Age Group 

Signature: __________________________________________________________ Date ____________________

Parent Signature (if under 18) ______________________________________ Date ____________________

My signature is in agreement to the following Waiver:

In consideration for being accepted, I for myself, my heirs, executors and administrators waive and release any and all rights against the Squannacook River Runners, the sponsors, the Town of Groton, the Groton-Dunstable Regional School District, USATF and organizations holding this event arising from my participation in the Groton Road Race. USATF New England and all of its officers and/or representatives shall be free from any liabilities or cliams for damages arising by reason of injuries to anyone during the conduct of this event. I have trained and am medically fit to participate. I grant permission to all the aforementioned to use my photos or videos for any legitimate purpose.