30k_registration_form_redraft[1]

Run 4 Kids: 30K Relay & 5K Walk Date: Where: Course: Time:

30K Relay & 5K Walk The Run 4 Kids 30K Relay supports the Christian Activity Center, An after school service for kids grades K K-12. Daily, the CAC provides tutoring services to enhance each child’s educational development and outlets for recreation to further their social skills. Healthcare is provided through recreation, health education, and practical assessments. Join us in our Run 4 Kids 30K Relay. The order oof runners will be 5K-10K-10K-5K. Any variation will result in team disqualification. If there are any ny roster changes, team captain captains must inform race officials no later than 7:10 A.M. on race day; a $10 charge will be added. A substitute is permitted for an additional $25. T-shirts are available to the pre-registered (August 2) 2). Walkers are also invited to stroll in one 5K stride, which will occur during the Run 4 Kids 30K Relay. So come come,…exercise…and socialize, and share with children in East St Louis and with your friends. T-shirts are available to the pre--registered (August 2).

November 7, 2009, Saturday Forest Park: St. Louis, MO Smooth & Semi-hilly Semi roads Late Registration (All): 6:45-7:10 A.M. Start-Finish Runners: 7:30 – 11:30 A.M. Start-Finish Finish Walkers: Walker 7:20 – 12 Noon

Divisions:

Men (4 Men) Women (4 Women) Open (4 Coed mixed)

Walkers (Each individual walks one 5K) Entry Fee: Runners $100/Team

Walkers $12/Individual $30/Family (4 min) (Pre-Registration: Registration: Postmarked by August 2)

$120/Team

$15/Individual $35/Family (4 min) (After Postmarked Date)

$140/Team

$ 20/Individual $40/Family (4 min) (On Race Day: November 7)

All who pre-register (August August 2) will receive a t-shirt (S, M, L, XL) Packets: To Be Announced (www.cacesl.org)

The course map and guidelines are on this form’s back. Send team’s registration form and payments to the address below.

Prizes:

Russell Smith, Race Director CAC P.O. Box 2525 540 N. 6th St. East St Louis, IL 62201-1320 Email: [email protected] Phone: 618-874-5615 x 200 Website: www.cacesl.org: Online Registration Available

1st, 2nd, 3rd place medals/division medals/ for Run Relay

Parking:: Located at Start/Finish (Upper Muny Lot) Additional Incentives: 1. SplitMaster Timing/Race Mgt: professional timing 2. Long sleeve t-shirts shirts for pre-registered pre entrants (Aug 2) 3.. Runner’s World: Sponsorship of Runners’ bibs 4.. Deaconess Foundation: Resource for timing device 5. Bagel s for runners & walkers: walker limited supplies 6. Online Registration: www.active.com

--------------------------------------------------------------------------------------------------------------Team Name __________________________________ Team Captain/Walker/Donor:

1 ____________________________

_______/_______/_______ _______

Walker Fee: $12 Pre-Registration (post-marked marked by August 2) $15 Post Registration (post-marked marked after August 2) $20 On Race Day: November 7

Age

/ Gender / Size

2 ____________________________

_______/_______/_______

3 ____________________________

_______/_______/_______

4 ____________________________

_______/_______/_______ __/_______/_______

Additional $25→→→→→→ → → → Substitute: ubstitute: ___ ____________________________

_______/_______/_______ ______/_______/_______

Teammates’ Names: Team Fee: $100 Pre-Registration $120 Post Registration

Team Captain’s/Walker’s/Donor’s Address:

__________________________________ (Street, Street, City, State, Zip)

Team Captain’s E-mail: ___________________________________ Divisions (Circle One):

Men

Women

Waiver of Liability and Consent to Publication:

Open

Mail Registration Form and Entry Fee to: Christian Activity Center P.O. Box 2525 East St Louis, IL 62201 Memo: “Run 4 Kids”

Phone _________________________ Walker Located On Backside of Registration Form

I, the undersigned, being eighteen (18) years of age or older, have read and understand the foregoing waiver located on the back, back accept and agree to its terms and sign it voluntarily.

1 ___________________________ 2 __________________ __________________________ 3 __________________________ ______ 4 _________________________ __________ (Parent’s Signature if under 18) (Parent’s Signature if under 18) (Parent’s Signature if under 18) (Parent’s Signature if under 18) Substitute’s Signature: _____________________________ (Parent’s Signature if under 18)

Option: I can not run or walk the Event; vent; I would like to donate $ _________ to the Christi hristian Activity Center.