Last Name: 
    First Name: 
Street Address: 
          City: 
         State: 
      Zip Code: 
     Telephone: 
      Birthday: 
       	   Age: 
    
         Email: 

  
Each race is $3

    

    Race dates are

    May 27

    June10

    June 24

    July 8

    July 22

    August 5

    August 19

    

    I attest and verify that I am fully aware of the rigors and dificulties in 
    cross country racing, and fully understand that I may become injured, partially 
    or wholly as a result of my participation in said events in question to be 
    during the summer of 2004, and do hereb verify that I am physically and mentally 
    fit to participate and complete this race.

    

    Signature ________________________________

    

    Mail entry to VCTC, Box 341,Bronx, NY 10471