m/w cross country 5K/3K sign up

4th Annual PSC 5K Run / 3K Walk
Saturday - July 31, 2010 - Sign Up Form
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Event Organizer - Oscar Espinosa - 709-2943

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2008 5K/3K Run Walk

Name:
Street:
City:
State:
Zipcode:
Home Phone:
Cell Phone:
Email: (required field)
Age (on 7/31/10)
male or female
T-shirt size size	*Event T-Shirts will only be given if participant registers prior to July 16th.
	Select an Option: 5k (3.1 mile) Run 3k (1.8 miles) Walk Volunteer Event Fees: 5k Run (9:30 a.m.) $20 early; $25 event day $15 student early (with ID); $20 event day 3k Walk (9:35 a.m.) $12 early; $15 event day To avoid long lines the day of the Event, event fees can be paid in advance at the PSC Athletic Complex located in the Field House. Make checks payable to: Prairie State College, Memo: 5K Run. Directions For more information regarding event fees, call either Barb Graf (708) 709-7837or Chris Kuchta (708) 709-3950. Packets will not be available for pickup before July 29.
	BY SIGNING THIS FORM YOU MAY BE GIVING UP CERTAIN RIGHTS. BEFORE YOU SIGN, BE SURE YOU READ AND UNDERSTAND THIS FORM. AUTHORIZATION, CERTIFICATION, WAIVER AND RELEASE: The undersigned, for and in consideration of being given the opportunity to participate in the Prairie State College 3rd annual 5K Run (“Event”), to be held on July 31, 2010, hereby releases and waives any and all claims for himself, his heirs, dependents and assigns, against the Prairie State College, and other participating agencies, and all their officers, employees, agents, volunteers, and sponsors, from any and all liability whatsoever for any injuries, damages and claims that may arise out of this participation. I fully recognize that a risk of injury exists and I assume all risk. I certify that I am physically fit and will have trained sufficiently for the event. I also grant permission to Prairie State College and its authorized agents to use my name and photograph, video tapes, motion pictures, recording and any other public relations account of the event for any purpose, including commercial advertising without monetary payment.
(Type "I Agree" to the above Waiver)