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Registration Forms


The Salem Park, Recreation & Community Services Department Presents:
The Derby Street Mile Run!
Friday, August 20, 2010
  in Salem, Mass, 7:00pm & 7:15pm
Race starts on Fort Ave & finishes at Pickering Wharf!
Entry fee: $14 pre-race day $15 on race day,  USATF Certified number MA07017JK
Awesome Technical short sleeve shirts given to first 300 entrants!!
Two races, enter your choice “Family or Competitive” Run
Competitive run 7:00 pm – Top 3 in age groups will receive awards in Competitive run
Family Run 7:15pm - all runners in Family run will receive medals
Post Race: at Waterfront Hotel & Suites - refreshments, water, soda, and fruit
Information: Contact the Salem Park, Recreation & Community Services (978) 744-0180 or

In consideration of this entry being accepted, I hereby for myself, heirs, executers and administrators waive and hereby release any and all rights and claim for damages
I may have against the City of Salem Park, Recreation and Community Services  Department of any and all injuries suffered at said event, while traveling to or returning therefrom

Name:_______________________________ Age:____    Male:__ Female:__

RACE entered (check one)  COMPETITIVE Run 7:00pm ____FAMILY Run 7:15pm___  

Address:_________________________________ City:___________ State:_________

Zip:__________Phone:_________________EMAIL:___________________________

__ __________________________________ Date:_______tshirt size S__M__L__ XL___
Signature   (parent or guardian signature required if under 18 yrs of age) Send registration & check to: Salem Park, Recreation and Community Services, 5 Broad Street Salem, MA. 01970 c/o Derby Street Mile!



 
Salem City Hall 93 Washington Street, Salem, MA 01970
Phone: 978-745-9595
   City Hall Hours of Operation: Monday, Tuesday & Wednesday 8AM - 4PM Thursday 8AM - 7PM Friday 8AM - 12PM
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