6th Annual Maryland Eastern Shore Marathon Swim

10 N. Miles in the Chesapeake Bay around the Poplar Islands

May 20, 2001
Entry Aplication

Name:
________________________________________________________________

Address:
________________________________________________________________ ________________________________________________________________
________________________________________________________________

Telephone:

(day)_____________________________
(evening)__________________________
(FAX)____________________________

Email address:
_______________________________

Date of Birth:
_______________________________

Social Security Number:
_______________________________

Estimated Time to Complete Swim:
_______________________________
Medical/Other Information to declare:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Statement on open water experience (dates, distances, time):
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
WAIVER AND AGREEMENT
As a condition of being accepted in the swim, I agree to raise the minimum amount of pledge money ($300) before the event; to attend the required May 19, 2001 pre-swim meeting; to adequately train for the swim; to abide by event rules and regulations including water safety determinations that may result in my removal from the water if deemed to be in danger; to accept medical treatment deemed necessary during the event; and to hold harmless by acknowledging and assuming the risks involved in an endurance activity of this nature and for myself and heirs waive all claims for damages or injury arising during the event against any individual, group, association, agency or government body involved with this activity's organization, conduct, and/or support.

Signature: _______________________________ Date: ____________

Please sign and mail this sheet to:

Joe Stewart
3212 Avon Ave.
Baltimore, MD 21218
For more information:
     Call (410) 243-4418