Fowler 4^th of July 5K

When: SUNDAY, JULY 3, 2011

RACE DAY REGISTRATION:

7:15 AM – 7:45 AM

5K RUN/WALK BEGINS AT 8:00 AM

Where: FOWLER TOWN PARK, NEAR THE GAZEBO

Who: 5K RUN/WALK OPEN TO ALL AGE GROUPS

Top finishers in each age group receive awards!

Those who pre-register by Friday, June 24 will receive a race t-shirt!

PROCEEDS FROM THE RACE WILL BENEFIT THE BENTON COMMUNITY FOUNDATION AND THE FOWLER SENIOR CENTER

ROTARY PANCAKE BREAKFAST FOLLOWING THE RACE!!!!!!!!!

Questions? Email fheim@benton.k12.in.us

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Fowler 4^TH of July 5K Run/Walk Registration

Name: ___________________________________ Age: _______ Sex: M F

Address: __________________________ City: ________ State: ____ Zip: ________

Date of Birth: ____________ Phone: _________________ Email: _________________

Please check the event below you plan to enter:

5K Run ($15.00): ______ 5K Walk($15.00) ______ Shirt Size (circle one): S M L XL

Please make all checks payable to Benton Community Foundation. Youth sizes: YS YM YL

Registrations can be mailed to:

Benton Community Foundation

PO Box 351

Fowler, IN 47944

Waiver

In consideration of the acceptance of this entry, I waive for myself, my heirs, and their assigns, any and all claims for damage against the Town of Fowler, their sponsors and their representatives in connection with my participation in the 2011 Fowler 4^th of July 5K Run. I attest and verify that I have full knowledge of the risks of this event. I am physically fit and sufficiently trained to participate.

Signature: _________________________________ Date: _________________

*Form must be signed by race entrant. If entrant is under 18 years of age, a parent or legal guardian must sign entry form.