5K Run for Veterans registration form

5K Run for Veterans
Saturday, May 2, 2015
10:00 AM
Thompson Park. Watertown, NY
Registration Fee- $25- ages 10 and up / $20- Veterans and Active Duty Military
Proceeds to benefit the Veterans Outreach Center
*First 100 registered are guaranteed a t-shirt*
Pre –register by mailing or dropping your form off to : Veterans Outreach Center
146 Arsenal Street Box 5 Watertown, NY 13601 or emailing
[email protected]
Make checks payable to : Utica Center for Development. Registration fees are non
refundable. Cash or Check only please.
Race day registration will take place at the Thompson Park Pavilion across from the
zoo parking lot from 8:30AM-9:45AM.
First Name ______________ ___ Last Name ____________________
Address _________________________________________________
City/State/Zip ______________________Male _____ Female ______
Date of Birth ___________ E-mail Address ______________________
Are you a Veteran? Yes ____ No ___ Shirt size (Circle One) S M L XL
Liability Waiver: I understand and agree that I am voluntarily participating in the 5k Run for Veterans, at
my own risk. I should not enter unless I am medically able. I waive and release the Veterans Outreach
Center, the city of Watertown and their representatives from all claims or liabilities of any kind arising out
of participating in this event. I further hereby grant full permission to any or all of the foregoing to use
photographs, videotapes, recordings or any other record of this event. Must be signed to participate
Parent/Guardian signature if under 18/Date
*For additional Registration Forms email: [email protected]*