5K Run/Walk

To benefit the

Leukemia and Lymphoma Society

Date: July 31^st

Time: Pre-registration begins at 6:45am

Race starts at 7:45am

Entry Fees:

Pre-register $7 minimum donation (Before July 16^th)

Day-of registration $8 minimum donation

Prizes:

Top male and female finisher

Top male and female walker

All participants will be entered into a drawing for prizes

Race will be held at the Celery Bog scenic nature trails (1620 Lindberg Road, West Lafayette). Check-in will be outside of the Lilly Nature center.

For additional information call or email: 430-5086 or jlathert@purdue.edu

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PRE-REGISTRATION FORM

First name________________________ Last name_____________________________

Address_________________________________________________________________

City ____________________State_____________ Zip_________ Phone_____________

Age: _________ Gender: M/F Runner or Walker? __________

Pre-registrations fee is a $7 minimum donation. Amount enclosed ________

Please make checks payable to “The Leukemia and Lymphoma Society”

Waiver

In consideration of the acceptance of my entry, I for myself, my executors, administrators, and assignees, do hereby discharge the City of West Lafayette, Leukemia and Lymphoma Society and all persons connected with this event for all claims of damages, demands and actions what so ever in any manner arising or growing out of my participation in this event. I attest and verify that I have full knowledge of the risks involved in this event, and I am physically fit and sufficiently trained to participate in this event.

Print name__________________________ Signature___________________________

Date____________ Parents signature (if under 18) ______________________________

(Send pre-registration form to 5228 West 350 North, West Lafayette IN, 47906)