Name________________________________________________________________

Age____________ Date of Birth _______________Sex____________

Street Address:________________________________________________________

City______________________________________ State_____________ Zip________

In consideration of the forgoing event, I for myself, My executor, Administrators, and Assigns, do hereby release and discharge the sponsors of the GreenStreet Mile from all claims arising from this participation in the above named event. I am physically fit and have properly trained to participate in this event.

_________________________________________________________________

Signature (parent or guardian if under 18)

T-shirt size:   (  ) Sm (   ) med    (   ) lg    (   ) X-lg .

Mail To:

Tupelo Running Club

Green Street Mile

P.O. Box 511

Tupelo, MS 38802

July 4th 2008

7:00 A.M.