Last Name ____________________

First Name __________________

M. I. ___________

Street Address ___________________________________________________________________

City __________________________

State / Province __________________________________

Zip / Postal Code _______________

Country (If not USA) _____________________________

Phone Number  (____) __________

e-Mail Address (Optional) _________________________

Sex M/F _____

Age on 04/05/2008 _________

T-shirt Size  S   M   L   XL

Number Of Previous Ultramarathons ____________

Fastest 50K ______________________

Number Of Previous Chicago Lakefront 50Ks ________

Where did you find out about this race? _______________________________________________

Entry Fee (Please circle one)

Regular

Chicago Area Runners Association Members

Through February 17, 2008

$30

$28

February 18 - April 3, 2008

$40

$38

April 4 & 5, 2008

$50

$48

CARA Member Number (__________)

THIS IS AN IMPORTANT WAIVER OF LIABILITY. READ CAREFULLY BEFORE SIGNING.  In consideration of your accepting this entry and other good and valuable consideration the receipt and adequacy of which I hereby acknowledge, I, the undersigned, intending to be legally bound, hereby, for myself, my family, my successors, assignees, heirs, executors and administrators, forever waive, release and discharge any and all rights, claims for damage, causes of action whether in law, equity or otherwise, known or unknown, that I or any of them may have against the Chicago Lakefront 50k - George Cheung Memorial Race (the "Event"), ChicagoUltra.Org, the Chicago Park District, the City of Chicago, the State of Illinois, the Chicago Area Runners Association, Fleet Feet Sports, Chicago, Chicago Amateur Athlete, all sponsors of the Event and their officers, directors, employees, volunteers, independent contractors, agents and representatives, successors and assigns, for any and all injuries, illness or other harm suffered by me in or as a result of the Event. No refunds if Event cannot be staged because of act of God or is not staged or cancelled for any reason. ChicagoUltra.Org reserves the right to cancel the event and shall not be liable for any actual or consequential damages. I attest that I am physically fit and have sufficiently trained for the completion of the Event and that my physical condition has been certified by a licensed medical doctor. I am aware of the dangers and precautions that must be taken when running in warm or cold conditions and on uneven surfaces. I will abide by the decision of any race official and the rules of ChicagoUltra.Org. I also agree to abide by any decision of an appointed race official or medical official relative to my ability to safely continue or complete the Event. I further assume and will pay my own medical and emergency expenses in case of an accident, illness or incapacity regardless of whether I have authorized such expenses. I am over 17 years old. I hereby grant permission to ChicagoUltra.Org to use any photographs, videotapes, motion pictures, recordings or any other record of this event for any legitimate purpose including commercial advertising. I have read this waiver carefully and understand it.
 

__________________________________________ Date: _______________________
                              Signature of Applicant