First Name_____________________________  Last Name ______________________________

Address _______________________________________________________________________

City ______________________________________   State _____  Zip ___________________

Phone _______________________________  USATF# _________________________________

Date of Birth _______________________________  Age _____________     Sex     5M     5F

Event (check one) 55K Race    510K Race      
                          51 Mile Health Walk    5 1 Mile Kid's Fun Run (11 & under)  
                               

Payment:   Make checks payable to: Holy Trinity Cathedral
                                                        279 South 300 West
                                                        Salt Lake City, UT 84101
                               Entry fee of $20 is non-refundable.

Waiver:    Signing below indicates you are aware of the dangers of a running event and that you  have fully prepared (must be signed)  for its rigors, additionally, you release any sponsors and/or affiliates of legal liability with the Event.

Signature Entrant __________________________________________   Date_________________

Signature Parent or Guardian____________________________________________    Date______________________