2008 Registration Form
(Please print this form, complete in full,
and mail to address below)
Name: __________________________________________
Street: ___________________________________________
City, State, Zip: ____________________________________
Email: ____________________________________________
Phone: ________________ Birthdate: __________________
[ ] Female [ ] Male Age: _____
Shirts are presented to the 1st 200 5K participants. Please indicate your selection below:
Shirt Style (circle one): Tee Tank Top
Size (circle one): Child Large Adult Medium Adult Large Adult X-Large
| Event | Preregistered $ | Check Event |
Day-of-Race $ |
| 5K Run | $15.00 | [ ] |
$18.00 |
| 5K Walk | $15.00 | [ ] |
$18.00 |
| 5K Run & Fun Run | $18.00 | [ ] |
$21.00 |
| Fun Run (w/o shirt) | $3.00 | [ ] |
$ 3.00 |
| Fun Run (w/ shirt) | $10.00 | [ ] |
Note: Shirts may be available for purchase on race day; limited availability.
Complete only for team membership:
| Team Type (circle one): | High School Corporate/Adult |
| Team Name: | ____________________________________ |
| Team Captain (need not run): | ____________________________________ |
|
Release Form (Mandatory) In consideration for acceptance of this entry, I, intending to legally bind myself, my Heirs, Executors, & Administrators, do hereby waive and release any and all rights and claims for damages, injuries, or losses I may have against any and all event officials, and all organizations conducting this event (including but not limited to the Alburtis Area Community Center, Borough of Alburtis, County of Lehigh, and event sponsors, volunteers, rescue and support personnel as well as their agents, successors and assigns). I additionally assume full responsibility for taking cognizance of weather and course conditions at race time. It is my further declaration that I consider myself to be in physical condition that will enable me to participate in this race. I understand that images/photographs may be taken of me during this event which may be used for promotion of this and future events. ______________________________________________ ______________________________________________ |
Amount Enclosed: __________ (checks payable
to: Alburtis Area Community Center) (non-refundable)
Please mail completed form (postmarked no later than
August 2, 2008) to:
AACC - Alburtis 5K
PO Box 381
Alburtis, PA 18011