REGISTRATION FORM
 


The Race for Riley is a 5k walk/run created to raise awareness and funds for The Joseph Sams School. Come early for the run. Stay for the fun!

Saturday, April 25, 2009
5k Run/Walk - 8:30 a.m.
1Mile Run - 9:15 a.m.
Tot Trot - 9:30 a.m.


Check one of the following:

5K Run           1 Mile            Tot Trot
($20 by 4/17/2009, $25 after 4/17/2009 and on race day.)

Phantom - $25 (I can't be there, but I support the cause; please mail my shirt to the address below)

T-Shirt size (check one): YS YM S M L XL

Make check or money order payable to: The Joseph Sams School (c/o Race For Riley)

Name:

Age (as of race day): Sex: Male Female

Address:

City: State: Zip:

Email:

Phone: Date:

Signature:
(If under 18, signature of parent / guardian)

WAIVER & RELEASE: I am in proper physical condition to participate in this event. In consideration ofacceptance of this entry, I waive any and all claims for myself and my heirs against officials, volunteers, and/or sponsors of Race for Riley 5K/1 Mile/Tot Trot Run for any injury or illness which may directly or indirectly result from my participation. I grant permission to all of the foregoing to use any photographs, motion pictures, recording or any other record of this event for any legitimate purpose. I understand that radio/tape/CD headsets, dogs or other animals, in-line skates, skateboards and bicycles are prohibited and that violation of this prohibition will result in disqualification.

Print and Mail completed form and payment to:

Race For Riley
c/o Race For Riley
280 Brandywine Blvd
Fayetteville, GA 302145

 

Questions?
Please call Waynette Peek at 770-463-0714. Or email at waynette@raceforriley.org.