Fallen Heroes Run Sign up form

WHEN: May 15^th, 2010

REGISTRATION: 7:30AM-8:20AM

RACE START: 8:30AM

WHERE: LINCOLN HIGH SCHOOL PARKING LOT

RYAN AVE AND SACKET ST.

PRICE: Eighteen ($18) Dollars before May 12, 2010 and

Twenty ($20) Dollars on Race Day made payable to the Mayfair Business Association

3530 Cottman Ave., Phila., PA 19149

ALL PROCEEDS BENEFIT THE HERO THRILL SHOW

FOR THE EDUCATION OF THE SURVIVORS OF FALLEN POLICE AND FIRE AS WELL AS THE MAYFAIR MEMORIAL PLAYGROUND

"This event is sanctioned by USA Track & Field."

5k – Entry Form

Name ____________________________________________ Age______

Address (Street) ____________________________

City _______________________ State ____ Zip Code ____________

Phone (_____) ______________ Email _________________________

Emergency Contact (Name and Phone)________________________________________

Are you a Philadelphia Firefighter or Police Officer? (Y/N)

I will participate in the Run ____ Walk ____

Liability Waiver Must Be Signed

I know that participating in a 5K RACE is a potentially hazardous activity. I should not enter unless I am medically able and properly trained. I agree to abide by any decision of the race officials relative to my ability to complete this race safely. I assume all risks associated with running in this event, including, but not limited to falls, contact with other participants, the effects of weather, including high heat and humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. 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 Mayfair Business Association, Civic Association or Community Development Corporation, their representatives and their successors and all race-day volunteers from all claims or liabilities of any kind arising out of my participation in this event.

In consideration of the safety of all participants, I understand that no baby joggers or strollers, headphones, animals on a leash, skateboards, roller blades or bicycles are allowed on the course. In addition, I understand that if the race is cancelled by circumstances beyond the control of the organizers, my entry fee will not be refunded.

SIGNATURE ________________________________________________________ Date _____

(Parent or Guardian if under 18)___________________________________________________

Online Registration - visit www.mayfairbiz.com/run and pay via Paypal