MAIL-INS MUST BE RECEIVED BY AUGUST 29, 2011.

        Name:  
     Address:  
        City:  
       State:     Zip:    Club: 
  Home Phone:      Date of Birth: 
                             Age on race date: 

       Event: 5 Mile 10 Mile

      Gender: M F     Shirt size: M L XL

  Entry fee:  $16(received by August 29, 2011)
              $12(under 17 years or over 70 years old)
              $18(race day registration; bring this form on race day)
  All registered entrants will receive a pass to the fair.

  ALL ENTRANTS MUST SIGN RELEASE STATEMENT

Waiver: In consideration of the acceptance of my entry, I do hereby, for myself, my heirs, 
executors and administrators waive, release, and forever discharge any and all rights and
claims for damages which I may have against any sponsor or official of the 37th ANNUAL 
AMIGO de ORO RACE at the Mariposa County Fair (35-A District Agricultural Association) 
held Sep. 4, 2011. I am physically fit and have trained for the race.

__________________________  _____________ ________________________________
Signature                   Date          Parent's Signature if under 18