| Print this form and mail it to: The East Hampton Chamber of Commerce, 79 A Main Street, East Hampton, NY 11937 |
|
presents the GEORGICA JOG / 5K RUN-WALK SUNDAY, OCTOBER 5, 2003 Sponsored by Cross Sound Ferry & Suffolk County National Bank PLACE: Main Beach, East Hampton RACE BEGINS: 10:00 a.m. CHECK-IN: 9:00 - 9:30, Main Beach Pavilion ADVANCE REGISTRATION: $15.00 DAY OF THE RACE: $20.00 Under Age 12: $10.00 No baby strollers allowed. Awards to first, second and third overall male and female. Male and female awards to the first three finishers in the following categories: 8 and under, 9-11, 12-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85+. Trophies to the first, second, and third male and female race walkers. Refreshements. T-shirst will be given to all pre-registered participants. T-shirts will also be distributed to participants that register on the day of the race while supplies lasts. AWARDS NOT DUPLICATED Racer Type (Runner or Race Walker) ______________________________________________ Gender ______________________________________________ Shirt Size (S, M, L, XL) ______________________________________________ Age on Day of Race ______________________________________________ Birth Date ______________________________________________ Name ________________________________________________________ Address ______________________________________ Apt. ______ Town _____________________ State ___________ Zip ________________ Phone _________________________ Make check payable to: The East Hampton Chamber of Commerce, 79 A Main Street, East Hampton, NY 11937 Waiver: In consideration of this entry, I hereby signify my understanding that the Town of East Hampton, the Village of East Hampton, the East Hampton Chamber of Commerce and ll other organizations, businesses and individuals associated with this event are not to be held responsible for any injuries which I may suffer from this connection. I hereby waive any claims for damage to my person or property. Furthermore, I hereby represent that I am physically fit and adequately trained for this event, and that I fully understand the risks in running in this event. Signature ___________________________________________________ Date ________________________________________________________ Parent's Signature __________________________________________ |