2007 MONTGOMERY COUNTY ROAD RUNNERS

EXPERIENCED MARATHONERS TRAINING PROGRAM

 

Name       Date of Birth       Gender M F

 

Home Address     

 

City       State       Zip      

 

Home Phone       Work Phone       E-Mail Address      

 

Occupation       Employer      

 

MCRRC Member? No Yes, since       Singlet size: S M L XL

 

Number of years running:       Average Weekly Mileage for past month:      

 

Longest run in past month:       Number of days you run per week:      

 

No. of marathons run:      Most recent marathon:       Time:      

 

Most recent 5K/10K time:       Name and date of race:      

 

Marathon you are training for (name & date):      

 

How did you find out about this program?      

 

Liability Waiver: I understand that running and training for a marathon are potentially hazardous activities which include the risks of injury and death. I understand that I am solely responsible for my health and medical condition, and that it is my responsibility to determine, along with my own physician, my physical and mental fitness to undertake a strenuous marathon training program. I assume all risks, including injury and death, associated with or arising out of my participation in this marathon training program, and I hereby waive and release the MCRRC, its officers, directors and the coaches of this marathon training program from all claims and liabilities of any kind or description arising out of my participation in this program.

 

Signed:_________________________________ Date:_________________________

 

Return with your check payable to MCRRC. $100 MCRRC members; $150 non-members. No refunds after program begins. Mail to: Mike Broderick, 17723 Garrett Drive, Gaithersburg, MD 20878. (301) 921-1086.

 

DO NOT WRITE BELOW THIS LINE

Payment date:       10K Time:       Pace:       Threshold Pace:      

 

5K pace:       Projected Marathon Pace: