

FAMILIES FIRST 5TH ANNUAL 5K
RACE & 1 MILE FUN WALK
Official
Entry Form
Time: 9:00 AM - Registration will begin
Please submit a separate
form for each participant. Photocopy or
print more as needed. Awards given for
the fastest overall male and female, and top three finishers in each age
category. One mile fun walk is
noncompetitive.
Non-Refundable Entry: $15 per person or $30 for a family of three
before September 30th; $18 per person after September 30th. Family entries must be mailed together. Entry includes quality T-shirt, bagels,
family entertainment, and an opportunity to support a worthwhile cause.
Name _________________________________ [
] male [ ]
female ___Run ___Walk
Address _______________________________ Age on October 6th ___________
City/State/Zip _______________________________________ ------ Shirt Size -----
Phone
_________________________ Date ___________ Adult: [ ]
S [ ]
M [ ] L
[ ] XL [ ] XXL
E-Mail _____________________________________________
Age Groups: 11 - 18 19 - 29 30 - 39 40 - 49
(circle
one)
50 – 59 60
and above
I assume all risks
associated with running this event, including, but not limited to: falls, contact with other participants, the
effects of weather, 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
our accepting my entry, Families First, race officials, volunteers, and all
sponsors, their representatives, and successors, are hereby and forever
released from any and all claims or liabilities of any kind arising out of my
participation in this event. I grant
permission to all of the foregoing to use any photographs, motor picture,
recording or any record of this event for any legitimate purpose.
________________________ ____________________________________________
Signature Signature (parent/guardian) if under 18
Checks payable to:
Families First Mail to: Families First Race Committee
c/o
Questions/Directions: Call
Thank you for supporting “Families First”
Fifth Annual
5-K
RACE 'N WALK
PREMIER
SPONSOR - $1,000 CORPORATE
SPONSOR - $500 (to $999)
§
§
Top logo listing on t-shirt* • Prime logo listing on t-shirt*
§
§
Mention in Pre-event
§
10 registrations for Run/Walk • 5 registrations for Run/Walk
§
Recognition in Newsletter • Recognition in Newsletter
LOGO
SPONSOR - $250 (to $499) NAME
SPONSOR - $100 (to $249)
§
Logo listing on t-shirt* • Name listing on t-shirt*
§
§
3 registrations for Run/Walk • 1 registration for Run/Walk
§
Recognition in Newsletter • Recognition in Newsletter
YES,
WE WOULD LIKE TO BE A SPONSOR FOR FAMILIES FIRST 5-K RACE ‘N WALK!
Company
Name _____________________________ Contact
Name __________________________
(as
it will appear in listing) Contact Phone Number
__________________
___________________________________________ Contact
Email__________________________
□
Premier - $1,000 □ Corporate - $500 □
Logo - $250 □ Name - $100
*Deadline for logo/name inclusion on t-shirt:
Make check payable to:
Families First
Mail to: 1620 Teels Road, Pen Argyl, PA 18072
For
information: Call