Khiet Luong Pennsylvania Environmental Council 1315 W alnut

Transcription

Khiet Luong Pennsylvania Environmental Council 1315 W alnut
Or register online:
www.fairmountparkconservancy.org
Click—>Donate NOW!—>Events—>5k
Khiet Luong
Pennsylvania Environmental Council
1315 Walnut, Suite 532
Philadelphia, PA 19107
You are invited to the
Place
Stamp
Here
Saturday, April 23, 2011
8am-12pm
63rd & Cedar Street
Philadelphia, PA
(Re)Discover your Park!
Registration
I am unable to participate, but will support the Cobbs Creek Park
through a tax-deductable donation of $__________________.
In consideration for accepting this entry and the granting of the right
to participate in the event, I, the undersigned, intending to be legally
bound, hereby waive, for myself, my heirs, personal damages I may
have against the Darby-Cobbs Watershed Partnership, Philadelphia
Parks and Recreation, Pennsylvania Environmental Council, Fairmount
Park Conservancy, City of Philadelphia, its partners, officers, directors,
employees and sponsors, and/or any person whomever for any and all
injuries, including death, that may result from my participation in said
event. I represent and affirm that I am in proper physical condition to
participate in this event as verified by a licensed physician and have
sufficiently trained for completion of this event. Further, I hereby grant
full permission to the above event to use my name and/or picture in
any newspaper, photographs, video tape, motion picture, recordings
or any other account of this event for any purpose whatsoever and
without any obligations of anyone to compensate me therefore.
Please Print Clearly:
The undersigned has read and voluntarily signed this release and
waiver.
Participant’s Name:____________________________________
_____________________________________________________
Participant’s Signature
To find out more info about us or to join,
visit: www.phillywatersheds.org
Street:______________________________________________
(Parent/Guardian must sign if participant is under 18).
City:__________________________State:_____ Zip:________
_____________________________________________________
Signature of Parent/Guardian
To register online for the 5k, please visit:
www.phillywatersheds.org/cobbscreek5k
Home Phone: _________________Work :___________________
Please join us on Saturday, April 23rd, for the First
Annual Cobbs Creek 5k. This run/walk is one of the many
new and exciting events happening in Cobbs Creek Park
this year.
With the help of the Darby-Cobbs Watershed Partnership’s
Public Education & Outreach Committee, this race will
help support new family programs in the park. In 1999,
the Darby-Cobbs Watershed Partnership was formed in an
effort to connect residents, businesses, and government
as neighbors and stewards of the watershed.
Online registration: www.phillywatersheds.org/cobbscreek5k
Waiver and Release
Or complete this form, include your donation (checks only please)
made payable to the Fairmount Park Conservancy, and return to
the pre-addressed label on the front of this brochure by Monday,
April 18th in order to participate on Saturday, April 23rd.
Registrations can also be taken on the day of the event – runners
will be charged an additional $5 fee.
Cost: Runners- $20
Walkers-$15
Kids (12 and under)-$10
Date:_________________________________________________
E-mail: _____________________________________________
Age: ___________ Many thanks to our sponsors:
Darby-Cobbs Watershed Partnership
Gender: M/F
T-Shirt Size (Circle): Small Medium Large X-Large 2XL
Emergency Contact:
Name: ______________________________________________
Phone:______________________________________________
Relation:____________________________________________
gLh
CONCEPTS
GRAPHIC DESIGN • GLHCONCEPTS.COM
Schedule of Events
Registration: 8:00 am
Warm-up: 8:45 am
Run Begins: 9:00 am
Walk Begins: 9:30 am
Start: 63rd & Cedar Street
End: Cobbs Creek Community Environmental Education Center
A bag check will be provided.
Parking is available along 63rd street, but we encourage the
use of public transportation:
By Train: Market-Frankford line to 63rd Street
By Bus: 21,31,42
Trolley: 34
For more information, please visit the website or call Mr. Khiet

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