REGISTRATION FORM "This event is sanctioned by USA Track & Field."

Online Registration - visit www.mayfairbiz.com/run and pay via Paypal

WHEN: May 19th, 2012 REGISTRATION: 7:30AM-8:20AM RACE START: 8:30AM WHERE: LINCOLN HIGH SCHOOL PARKING LOT

RYAN AVE AND SACKET ST. PRICE: Twenty ($20) Dollars before May 16, 2011 and

Twenty-Five ($25) Dollars on Race Day made payable to the Mayfair Business Association 3530 Cottman Ave., Phila., PA 19149

ALL PROCEEDS BENEFIT THE HERO THRILL SHOW FOR THE EDUCATION OF THE SURVIVORS OF FALLEN POLICE AND FIRE,

THE JOSEPH KONRAD HERO PLAQUE AS WELL AS THE MAYFAIR MEMORIAL PLAYGROUND

5k – Entry Form Name ____________________________________________ Age______

Address (Street) ____________________________

City _______________________ State ____ Zip Code ____________

Phone (_____) ______________ Email _________________________

Emergency Contact (Name and Phone)________________________________________

Are you a Philadelphia Firefighter or Police Officer? (Y/N)

I will participate in the Run ____ Walk ____

Liability Waiver Must Be Signed I know that participating in a 5K RACE is a potentially hazardous activity. I should not enter unless I am

medically able and properly trained. I agree to abide by any decision of the race officials relative to my

ability to complete this race safely. I assume all risks associated with running in this event, including, but

not limited to falls, contact with other participants, the effects of weather, including high heat and humidity,

traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this

waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone

entitled to act on my behalf, waive and release the Mayfair Business Association, Civic Association or

Community Development Corporation, their representatives and their successors and all race-day

volunteers from all claims or liabilities of any kind arising out of my participation in this event.

In consideration of the safety of all participants, I understand that no baby joggers or strollers, headphones,

animals on a leash, skateboards, roller blades or bicycles are allowed on the course. In addition, I

understand that if the race is cancelled by circumstances beyond the control of the organizers, my entry fee

will not be refunded.

SIGNATURE ________________________________________________________ Date _____

(Parent or Guardian if under 18)___________________________________________________