Millers Mutual Harrisburg Mile Corporate

      
                       Company:

Corporate Team Name:

           Team Member 1:

           Team Member 2:

           Team Member 3:

           Team Member 4:

           Team Member 5:

                         Address:

                                City:

                              State:

                                  Zip:

    Team Captain Phone:

     Team Captain Email:

Please note: To participate in the race, each team member must provide a signed release agreeing to the terms of the following conditions.

            In consideration of the acceptance of this entry to the Harrisburg Mile, I waive all claims for myself, my heirs and assigns, the sponsors, cooperating and coordinating groups, and any individuals associated with the event, and will hold them harmless for any and all injuries that may result from my participation. I further state that I am in proper physical condition to participate in this race.

            I also give my permission to the media to use my name and/or picture in any newspaper, broadcast, telecast or other account of this event, without limitation and obligation to anyone to compensate me further therefore.

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I understand that the release must be signed by each team member and returned prior to participating in the Harrisburg Mile Corporate Event.  Select Yes  

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