FAMILIES FIRST 8^th ANNUAL 5K RACE & 1 MILE FUN WALK

Official Entry Form

October 9, 2010 - Wind Gap Borough Park - Rain or Shine

Time:  9:00 AM - Registration will begin 7:45 AM on race day

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 or more before October 9^th;  $18 per person on race day.  Family entries must be mailed together.  Students - $10 entry fee.  Entry includes a quality T-shirt guaranteed to first 100 runners, a raffle ticket for prizes, and an opportunity to support a worthwhile cause.

Name  _________________________________       [    ] male    [    ] female   ___Run   ___Walk

Address  _______________________________      Age on October 9^th   ___________

City/State/Zip  _______________________________________       ------ Shirt Size -----

Phone _________________________ Date ___________  Adult:   [    ] S      [    ]  M        [    ]  L

                                                                                                            [    ] XL   [    ]  XXL 

E-Mail  _____________________________________________

Age Groups:   under 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 Plainfield Elementary School

                                                                                        Nazareth, PA  18064

Questions/Directions:  Call Phil Giaquinto (610) 746-4436 (M-F 7:15 am - 3:15 pm) or email at  This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Thank you for supporting “Families First”