Somerville Jingle Bell Run
December 18, 2016
$37 .00 Registration Fee
-DO NOT MAIL OUT AFTER 12/1 /16-
Your Name:
-----------------------------
Address: ______________________________
Town/State & Zip Code: _____________________
Telephone Number:
E-Mail Address (Required): ____________________
Weight:
DOB:_/_/_ Age on Race Day: __ Sex: ----
Event Tee Shirt Size: S , M,
L,
XL,
XXL (Circle One)
Emergency Contact Name : ____________________
Phone Number : -----------How Much Money Have You Enclosed: ____
WAIVER: In consideration of my acceptance of this entry I intend to be legally bound, hereby for myself,
my heirs, executors and administrators waive and release any and all claims for personal damage I may
have against the city or town that the event is being held in, organizers, B.A. Event Promotions, Somerville
Striders AC, Paul Collyer, City of Somerville, sponsors of the race, and I attest and verify that I am
physically fit and sufficiently trained for this event on December 18, 2016. I also understand that there are
no refunds regardless of the circumstances and that I must be present to receive my merchandise
at the time expressed to me prior to purchasing - we do not mail out.
Signature /Signature of parent if under 18
Date:_____
All spaces must be filled out, or application will not be accepted.
Please address all checks and money orders to
B.A. Event Promotions and mail to
B.A. Event Promotions 133 Walnut Street #3 Somerville, Massachusetts 02145
(617) 625-2140