Thank you for your continued support of the
Matt Weiner Memorial 5K
Starting at Deer Brook Swim Club
Jackson & Tavistock Roads - Medford, NJ
Sunday morning, June 22nd, 2008
5K at 8:00 a.m.
Register with this form by mail, online at Active.com, or in person
7:00 - 8:00 day of race - $20.00
all proceeds benefiting:
Children's Hospital of Philadelphia, Heart Health Study
and Heart Screening for local students
PRIZES: TOP 3 M/F EA. AGE GROUP, TOP M/F OVERALL
USATF CERTIFIED COURSE
PROFESSIONALLY TIMED AND PROFESSIONALLY MANAGED RESULTS
(registration form below)
1 Mile Fun Run at 8:45
registration day of race - $10.00
REFRESHMENTS PROVIDED BY MURPHY'S MARKETS
please detach below and mail to: Matt Weiner Memorial 5K - PO Box 651 - Medford, NJ 08055
check payable to: Matt Weiner Memorial
OR REGISTER ON ACTIVE.COM - search Matt Weiner Memorial 5K
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Race Entry Form
Name:___________________________ Age on Race Day:_________
Street Address:___________________________
City:____________________________ State:__________ Zip:__________
Phone:____________________________
Event Entered: 5K Run: ______ 1 mile Fun Run ($10): _____
T-shirt Size: YM_____ YL_____ AM_____ AL_____ AXL_____
Corporate Club/Team: __________________________________________
Release and Waiver: I hereby waive and release any and all rights and claims for damages I have against any organization, municipality or any individual associated with this event for any and all injuries suffered by me that may occur before, during, or after my participation in this event on June 22, 2008. I verify that I am physically fit and have sufficiently trained to fully participate in said race. I also give my permission without fee for use of my name and/or picture in any broadcast, telecast or print media account of this event.
Signature:__________________________________________________________ Date:_______________________
(signature of parent/guardian if applicant is under 18)
contact: Carol Wendel at carolwendel@comcast.net for more information.