1st Annual Dan Elwood Memorial Run for Hospice

DATE/TIME: Saturday, May 24, 2008, 9:00 AM.

LOCATION: General Clinton Park, Bainbridge, NY

REGISTRATION: $15 pre-registration fee will be accepted until Saturday, May 17th, after this date entrants may register the day of the race beginning at 8:00 AM for a fee of $20. T-shirts will be given to first 200 entrants.

Pre-registration forms may be sent to: Dan Elwood Memorial 5k Race c/o Brenda Parsons, Village of Bainbridge, 33 West Main Street, Bainbridge, NY 13733.

DIVISIONS: Male and female 14 & under, 15-19, 20-29, 30-39, 40-49, 50 & over.

Medals will be awarded to male and female first, second and third place finisher in each of the age divisions.

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Name ___________________________________ Phone _________________

Address __________________________ City ______________ Zip ________

Emergency Contact _________________ Emergency Contact Phone ______________

Age (as of 5/24/08) ____ Date of Birth _____ E-Mail Address _____________________

Circle One: Male Female Circle T-Shirt Size: M L XL

WAIVER AND RELEASE

I know running a road race is a potentially hazardous activity, which could cause injury or death. I should not enter and run unless I am medically able to properly train. I agree to abide by any decision of a race official relative to any aspect of my participation in the event. I assume all risks associated with running this event. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Town of Bainbridge, Chamber of Commerce, General Clinton Park and all sponsors and/or contributors involved in this event from all claims or liabilities of any kind arising out of my participation in the event, even though that liability may arise out of negligence or carelessness on the part of the sponsoring bodies. This release shall be binding upon my heirs, administrators, successors and assignors and those of the sponsoring organization. By this release I fully intend to discharge the said organization from any and all injuries or losses suffered by me while participating in and traveling to and from this event.

 

Signature _________________________________________ Date ________________________

 

 

Parents Signature (if under 18 years of age) __________________________________________