m/w cross country 5K/3K sign up

Sixth Annual PSC 5K Run / 3K Walk
Saturday - July 28, 2012 - Sign Up Form

Event Organizer - Oscar Espinosa - (708) 709-2943

5K Run Sign Up
5K Run Info Sheet
2012 Results / Video for 2012
Event Fees
5K Map Link

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All fields marked with an asterisk are required to be filled in to sign up for this event.

*Name:
*Street:
*City:
*State:
*Zipcode:
*Phone:
*Cell Phone:
*Email:
Age (on 7/23/12)
male or female
T-shirt size size	*Event T-Shirts will only be given if participant registers prior to July 16th.
	Select an Option: 5k (3.1 mile) Run 3k (1.8 miles) Walk Volunteer Event Fees: 5k Run (9:30 a.m.) $20 early; $25 event day; $15 early (student with ID); $20 event day (student) 3k Walk (9:35 a.m.) $12 early; $15 event day To avoid long lines the day of the Event, event fees can be paid in advance at the PSC Athletic Complex located in the Field House. You may pay via credit card at the business office located in the Main Building. Park in Lot A then walk into the Main Building. Make checks payable to: Prairie State College, Memo: 5K Run. Directions For more information regarding event fees, call or e-mail either Barb Graf (708) 709-7837 or Chris Kuchta (708) 709-3950. Packets will be available for pickup on July 26.
	BY SIGNING THIS FORM YOU MAY BE GIVING UP CERTAIN RIGHTS. BEFORE YOU SIGN, BE SURE YOU READ AND UNDERSTAND THIS FORM. AUTHORIZATION, CERTIFICATION, WAIVER AND RELEASE: The undersigned, for and in consideration of being given the opportunity to participate in the Prairie State College 5th annual 5K Run ("Event"), to be held on July 28, 2012, hereby releases and waives any and all claims for himself, his heirs, dependents and assigns, against the Prairie State College, and other participating agencies, and all their officers, employees, agents, volunteers, and sponsors, from any and all liability whatsoever for any injuries, damages and claims that may arise out of this participation. I fully recognize that a risk of injury exists and I assume all risk. I certify that I am physically fit and will have trained sufficiently for the event. I also grant permission to Prairie State College and its authorized agents to use my name and photograph, video tapes, motion pictures, recording and any other public relations account of the event for any purpose, including commercial advertising without monetary payment.
*(Type "I Agree" to the above Waiver)