Print this form and mail in with payment to:

Print this form and mail in with payment to: WORLD AIRLINE ROAD RACE

Official Use Only

P.O. Box 40119

Ottawa, ON Canada K1V 0W8

WARR 2004 ENTRY FORM

Last Name/Surname (PRINT CLEARLY):

First Name (PRINT CLEARLY):

PLEASE PRINT CLEARLY BELOW YOUR COMPLETE ADDRESS AS IT SHOULD APPEAR ON AN ENVELOPE FOR MAILING PURPOSES

E:Mail Address:

Tick √ if you are an AIRLINE Employee

Your two-digit Airline Code:

Example: OK for

Czech Airlines

Tick √ if you are NON AIRLINE

Name of Your Airline as shown on your pay check:

Your age as of

Sept. 19, 2004

Date of Birth: Month: Day: Year:

Tick/Check √

Your Sex

Male

Female

Tick/Check √ T-Shirt Size

Medium □ Large □ X-Large □

Entry Fee for 10K and/or 5K Races USD

$ 30.00

Plus Late Fee if postmarked after

August 6 up to August 20, 2004 $5.00 USD

Plus Awards Banquet Fee #_____ x $35.00 USD

TOTAL AMOUNT DUE WARR IN USD

Make checks in U.S. dollars, payable to WARR. Please do Not Send Cash! Entry Forms received

without payment, or postmarked after August 20, 2004 will not be processed until Race Week and

will be charged the additional fee of $10.00 USD. Entry fee at Registration is $40.00. Your Cancelled

Check is Your Receipt. There will be Race Week Registration, but NO RACE DAY REGISTRATION.

Mail To: WARR

P.O. Box 40119, Ottawa, ON Canada K1V 0W8

Waiver/Release: I declare that I take part in WARR with full knowledge of the consequences which may arise from participation in the WARR events and waive all claims for myself, my executors, administrators and assigns, covenant with the organizers and sponsors in the event of an injury or personal loss that I may suffer as a result of my participation.

A parent or legal guardian’s signature will be required for participants under the age of 18. I agree to sign a waiver/release prior to picking up my Race Packet.

Signature:____________________________________ Date:_____________________

(If under 18, Parent or Legal Guardian’s)