17 th. Annual

FRANK KUSH 5K & 1 MILE

Family & Dog Fun Run/Walk

5K Run ~ 5K Walk ~ 1 Mile

October 18, 2008

Tempe Town Lake

Benefiting The Frank Kush Youth Foundation

Registration Starts @ 7:00 a.m.

5K Run ~ 5K Walk Starts @ 8:35 a.m.

1 Mile Starts @ 8:40 a.m.

Registration Form

Make check payable to Frank Kush Youth Foundation

Mail to:  Arizona RunningEvents Co. ~ 5290 W. Melinda Ln. ~ Glendale AZ ~ 85308

Please fill in this form, print it out and mail it in WITH YOUR CHECK

Last Name:  First Name

Address:  

City:      State: Zip Code: 

Phone: Email:

Age on Race Day:   Gender:  Me  F 

Event: 5K Run  5K Walk  1 Mile Fun Run/Walk

ADVANCED REGISTRATION BY OCTOBER 8,2008

$10 ADULTS (16 yrs & Up) ~ $5 CHILDREN (15 yrs & Under)

$20 FAMILY OF 4**, $5 EACH ADDITIONAL FAMILY MEMBER

**Household members only

Late Registration after OCTOBER 8, 2008 & Day of Event

Adults: ~ $15.00

Children: ~ $5.00

Additional Family Members

Last Name	First Name	Age	Gender M-F	Event 5K Run~5K Walk 1Mile
1.
2.
3.
Total Amount Enclosed

T-Shirt Size Adult   S  M  L    XL

                    Kids     S  M  L

Please read the waiver and sign the form. Thank You.

RELEASE FORM (MANDATORY): All applications MUST be signed to enter this event. No entry accepted without fee. NO REFUNDS.

WAIVER:
In consideration of accepting this entry, I, the undersigned, intending to be legally bound hereby, for myself, my heirs, executors, and administrators waive and
release any and all rights and claims for damages I may have against the Arizona RunningEvents Co., USAT&F, Frank Kush Foundation, City of Tempe, or anyone associated with this event, their representatives, successors and assigns for any and all injuries suffered by me in said event. I will additionally permit the free use of my name and pictures in broadcasts, telecasts, newspapers, web sites, etc.

Signature:__________________________________________ Date:__________

Parent's Signature (if under 18 years of age) & DATE  _______________________________