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PARK FOREST SCENIC 10 & 5K (2007 ENTRY FORM)
(mail to: Park Forest Scenic 10, 350 Victory Dr, Park Forest, IL 60466)

Deadline:  Must be at our office by Aug. 31, 2007. No race day registration.
(One runner per application. Sorry, no refunds! No strollers or roller blades)

Check one: _____10-Mile        _____5K Fun Run        ____Children’s Race

Sex (M/F) ___    Age as of 9/3/07 __ __     Birthdate __ __ / __ __ / __ __

Last Name ____________________ First Name __________________  M.I __

Street Address _____________________________________________________

City _____________________   State _____ Zip ______________

Home Phone (     )  _ _ _ -  _ _ _ _         Work Phone (      ) _ _ _  - _ _ _ _

T-SHIRT SIZE
CIRCLE ONE:       S       M        L       XL         Youth(6-8)       Youth(10-12)        Youth(14-16)
 

ENTRY FEE
 Check one: (registration deadline: August 31)                                                                                          

  __ 10-Mile Run         $30(Aug. 3)              $_____
                                       $35 (Aug. 4-31)

  __5K Fun Run           $24 (Aug. 3)              $_____
                                       $29 (Aug. 4-31)

  __Children's Run       $8                              $  _____

 CARA member deduct $3 on $24-$29 or $4 on $30-$35
or USATF or Gold Cup deduct $2 (not cumulative)
 CARA # _______________________________
USATF or Gold Cup #______________________

 Check or money order to: Village of Park Forest

 ___Visa ___Mastercard   ____American Express       

Exp Date________

 Card # ________________________________

 Signature________________________________

SIGN THIS WAIVER!!
 (Unsigned waiver will not be accepted) 

   I, the undersigned hereby, for myself, my heirs, executors and administrators, here waive and release any and all rights and claims I  may have against the Village of Park Forest, the Illinois Association and the USA Track & Field, Chicago Area Runners Association, all sponsors, their representative, successors, assigns, for any and all injuries suffered by me in this event, including pre and post race activities. I attest and verify that I have full knowledge of the risks involved in this event, and I am physically fit and have sufficiently trained to participate, and that I will read and understand the Medical  Instructions included in the runner's packet. I grant permission for emergency medical treatment by competent medical personnel at this event. I grant full permission to use photos and records of this event.
                                                 ___________________________________      Signature of applicant
(Parent or Guardian if under 18)

 Date__________________________________