Goldsboro Walk/Run

5K Run

1 mile walk

Electronic Timing by Young and Associates

Proceeds will benefit the American Cancer Society

RELAY FOR LIFE

DATE:  August 5, 2006

TIME:  8:00 A.M. starting time for 5K          One mile walk will begin at 8:15

LOCATION:  Village of Walnut Creek (starts and finish at boat ramp).                             

Entry Fees:

CHECKS PAYABLE TO AMERICAN CANCER SOCIETY 

Free T-shirt to the first 100 entries to register

For more information please call: Kriquette Davis at the Family “Y” (919) 778-8557

                                                          Carolyn Plummer (919) 738-7770

Please mail completed entry form to:  Family Y

                                                                 1105 Parkway Drive

                                                                 Goldsboro , NC 27534

                                                                 Attn: Kriquette Davis     5K Run

Awards will be given to the top three males and females in each division. 12 and under, 13-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-plus

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _  _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 

Name________________________________________ Age at race time____________

 

Address________________________________________________________________

 

Phone____________________       ______________________    ___________________

                   Home                                             Cell                                     E-mail

 

T-Shirt size         Small     Med.      Large     X-large        Youth med.    Youth large

 

Event:         5K        one mile walk       

 

By signing this release and waiver, I acknowledge that running a road race is a potentially dangerous activity.  I should not entry the run unless I am medically able and properly trained.  I assume all risks associated with participating in the event.  Having read this release and waiver I understand I cannot make any legal claim against anyone that represents or act as agents with the race/walk.  I am or my child is a voluntary participation in the road race/walk.  I hereby release all agents, and representatives and all other sponsors, from all claims and liability of any kind arising out of or related to my (my child’s) participation in this road race. 

 

Signature of participant________________________________________date______________

 

Signature of parent if participant is under 18________________________________________