THE GREAT NEW YORK 100 MILE
RUNNING EXPOSITION
Saturday, June 23, 2012,
5:00 a.m.
Times Square
New York, NY
APPLICATION
First
Name:________________________ Last
Name:_______________________________
Address:________________________________________________________________________
City, State,
ZIP:__________________________________________________________________
Email:__________________________________________________________________________
Phone:_______________________________
Cell phone to be
used during race:_______________________________
Date of Birth
(mo/day/yr):____________________ Age on
June 23, 2012:___________
Emergency
Contact Name______________________________ Phone:______________________
Best 100 mile
race time:____________ Name and year of race:_____________________________
If no 100 mile
race, longest race and time:______________________________________________
T-shirt size:
____
Entry fee: $50.
Please make check payable to Philip McCarthy, or email to request PayPal payment instructions.
Send race
application and entry fee to:
Philip McCarthy
10 Hillside Ave.,
Apt. 5B
New York, NY
10040
I, on behalf of
my heirs and administrators, waive and release the race director, the Broadway
Ultra Society, New York City Parks and Recreation, the City of New York, New
York Ultra Running, the Metropolitan Athletics Congress, USA Track and Field
and their representatives and all persons associated with the event for any
claims of injuries and/or death suffered by me in the said event. I attest I am
physically fit to run/walk 100 miles.
Signature:___________________________________________
Date:_________________________