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:
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
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
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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________________________________________