Miller Park Zoo Entry Form

Make checks payable to: Miller Park Zoo Society

Send to:
1020 S. Morris
Bloomington, IL 61701

Date/Time:
Saturday,
March 6, 2004
9:30 am &
10:00 am

Check-in/Same Day Registration:
8:00 - 9:15 am
Zoo Building

More Information:
Kris
(309) 434-2824

Instructions on How to Register:
Print and complete this form. Mail it with your check to the address shown on the left of this page.

Please complete All of the following:
Name:
Street address:
City:
State:
Zip Code:
Email:
Sex:	M F
Phone:	(nnn)-nnn-nnnn
Date of Birth:	(mm-dd-yyyy)
Age on March 6:

Select one Shirt Size:
Size:	M	L	XL	No shirt for Critter Crawl

I Wish to Enter (select one):
5K stampede	3K stroll	1/4 mile Critter Crawl

Entry Fee (Non-refundable):
$18.00 for 5K/3K by March 1	$20.00 for 5K/3K after March 1 & Race Day
$3.00 for Critter Crawl	*Fees include the spaghetti/bread lunch
Discounts:
$2.00 LRC members
Number of Extra Meals: (at $3.00 per person in advance)

Upon accepting my application and consideration of allowing me to enter this event, which I agree is at my own risk and entirely of my own free will I hereby for myself and on behalf of my heirs, executors, administrators and assigns, waive, release and discharge the City of Bloomington, Miller Park Zoo, Lake Run Club, race organizers, race volunteers, sponsors and promoters from any responsibility or liability whatsoever for any losses, injury or other damage sustained in any activities during or surrounding the event.


Signature (Parent if under 18)	Date