Parm Move Manila Reg Form And Poster

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M.O.V.E. Manila Run REGISTRATION FORM Categories:

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10k men 10k women

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5k men 5k women 5k wheelchair

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Full Name (of individual athlete):

2.2k

Nickname:

Date of Birth (day /mo /yr):

Age (2009 less Birth Year) :

Gender Male Female

Shirt Size

Home Address:

Company / School /Organization:

Telephone #(s):

E-mail:

Person to contact in case of emergency:

Telephone #(s):

Payment Info: Amount: P_____________Received by: _______________________ of:__________ Date:__________, 2009

WAIVER / RELEASE FORM In consideration of my entry, I, my heirs, executors and administrators release and forever discharge the Organizers,its officers, staff, sponsors, servants, agents and subcontractors, instrumentalities, and all voluntary community groups, and all organizations assisting this event, producers, their agents and representatives of all liabilities, claims, damages or cost, which I may have against them arising out of, or in any way connected with my participation in this event. I understand this waiver includes claims based on negligence, action or inaction of any above parties. I fully recognize the difficulties of this event and declare that I am physically fit and able to compete in this event safely, and not have been told otherwise by a medically qualified person. Furthermore, I certify that I have secured for myself a life and accident insurance coverage up to the third party liability to answer for any damages or loss of life and property that may occur in this particular event. I agree that in the event of race cancellation due to storm, rain, inclement weather, wind or any other unforeseeable, or “act of God” conditions, my entry fee shall be nonrefundable. I have carefully read this entry form and agree to abide by all rules and directions of all race officials on the day of the race

_______________________________________ Participant’s Signature over Printed

_________________________________________ Name Signature & Name of Participant’s Guardian (For Participants below 18 years old)

--------------------------------------------------------------------------------------------------------------------------------------RECEIPT for Registration to the: M.O.V.E Manila Run 2009 Name:________________________________________ Amount Paid: Php ___________ Registration fee received by: ________________________________of ______________ Date: _______________, 2009

“M.O.V.E. Manila Run” 19 July 2009 Sunday 5:00am UP Diliman Campus For the benefit of the PARM FUND (Fund for the Upliftment of the Needy Disabled) And in support of the PARM-PMA Charity Clinic & various PARM Advocacies

REGISTRATION FEES (inclusive of a race singlet and number):   

P250.00 for 2.2K P300.00 for 5K P350.00 for 10K

DISTANCE AND CATEGORIES 10K MEN and WOMEN 5K MEN, WOMEN, WHEELCHAIR participants 2.2K men, women, wheelchair participants, children (Fun Run/Walk)

MEDALS and various prizes will be awarded to Top 3 Finishers for all categories of 5K & 10K races. FOR REGISTRATION AND RACE INQUIRIES Please contact:  Thumbie O. Remigio: 09156872380/ [email protected]  Dr. Renald T. Ramiro: 09173209198 / [email protected]  Dr. Melissa Z. Mercado: 09194138852 / [email protected] REGISTRATION SITES  The UP Bikers Tambayan. Beside the kiosk near the UP Diliman AS parking lot and in front of the Faculty Center. Look for Christian: Mobile # 09195116929  Club 650 Sports Center. 150 E. Rodriguez Jr Ave (Libis), Quezon City. Tel # 6370650, Fax # 6311356  The PARM Office. Room 808-810 Future Point Plaza 1, 112 Panay Ave, Quezon City. Look for Lei or Jane: Tel # 4159048 or 4101597  UP-PGH Dept of Rehabilitation Medicine. Taft Ave, Manila. Look for Dr. Jec dela Cruz: Mobile # 09178355532 or Dr. Mayla Tee: Mobile # 09178440380; Tel # 5218450 loc 2411 / 2403  Makati Medical Center Dept of Physical Medicine & Rehabilitation. Amorsolo St, Makati City. Look for Apol or Ruel: Tel # 8888951  Or deposit your registration fee at BDO Anonas-Kamias Branch Acct # 3988006417 with Account name “PARM MOVE” then fax your Deposit Slip and Registration Form to Fax # 4159048 or 4101597