18th Annual
Dreamcatcher Classic
Road Race & Fun Run/Walk 

Entry Form

                                   Name:_________________________________________________

                                  Address:________________________________________________

                                 City/Town:_______________________________________________

                                 State:_______________________Zip Code:____________________

                                Age:_________________________Sex:________________________

                                Telephone:_____________________E-Mail______________________

                                 5-Mile____2-Mile____Wheelchair-____Donation:____Volunteer:_____

                              Preregistration $20.00 until Fri. Nov. 19, 2010    Post registration $25.00 Race Day

In consideration of your accepting this entry, I hereby for myself, my heirs, my executors, administators,
waive and release any and all claims for damages I may have against the Julie Rodick Road Race/
Scholarship Foundation, any sponsors, and any individuals associated with this event, and will hold them
harmless for any injuries that suffered in connection with the Julie Rodick Road Race/Scholarship Foundation.


_________________________________________________________________
Signature (Parents if under 18 years of age) 

Make check payable and mail to:     Julie Rodick Scholarship Foundation
                                                        P.O. Box 176
                                                        S. Weymouth,  MA  02190
                                                        781-331-0600
                                                        E-mail:  DrCtchr@aol.com