| Race Entry |
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| 9/11 Tribute 5K run/ 1 Mile Walk Friday, July 4, 2008 Fees: $15 on or before 7/1/07; $20 after 7/1/08 $5 off per person for three or more family members,10 and under free T-shirts to all Pre-registered and while supplies last Net proceeds to benefit the G.R.A.C.E. Fund, the July 4th IDA Parade and a scholarship awarded to a Glen Rock High School senior in memory of the victims of September 11th. _____________________________________________________ Mail completed entry form to: Tribute Run/Walk, Theresa Roberts, 67 Waldron Ave, Glen Rock, NJ 07452 Make checks payable to: G.R.A.C.E. Name: _____________________________________________________ Address:___________________________________________________ __________________________________________________________ __________________________________________________________ Emergency phone:_________________ Email:______________________ Date of Birth:_______________ Race day age:______ 5K Run ___ 1 Mile Walk___ Male____ Female_____ T- Shirt Size: Sm__ Med__ Lge__ X-L__ Amount enclosed: ________ I am voluntarily entering and assume all the risks associated with participation in this event. I agree to hold all organizers of this event harmless from present and future claims and liabilities arising out of my participation. Signature:______________________________ (parent or guardian if participant is under 18 years old) |