Gaslight Festival 5K Run | Walk

Release of Responsibility
Tuesday, September 16
Partnered with:
The Chamber Jeffersontown
10434 Watterson Trail
Jeffersontown, KY 40299
Gaslight Festival
5K Run | Walk
In consideration of your accepting my entry, I
intend to be legally bound, do hereby for myself,
my heirs, my executors and administrators,
waive and release forever any and all rights and
claims for damages I may accrue against all
persons and agencies including but not
restricted to, The City of Jeffersontown,
Jeffersontown Chamber of Commerce, Kosair
Charities, Pacers and Racers Running Store, the
County of Jefferson and any other city involved
with promoting the race as listed by name, their
successors, representatives, and assigns for any
and all injuries suffered by me while traveling to
and from and while participating in the Gaslight
5K Run/Walk in Jeffersontown, Kentucky and I
hereby represent that I have full knowledge of
the risks involved in this event and I am
physically fit and sufficiently trained to
participate in this event.
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Signature of Entrant
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Date
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Signature of Parent/Guardian if Entrant is under 18
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Date
For more information contact
The Chamber Jeffersontown at
502.267.1674 or visit
www.jtownchamber.com/gaslightfestival.aspx
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7:00 pm
The race starts and finishes in front of Jeffersontown City Hall
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Registration
Packet Pickup
Mail: Fill out the attached registration form,
Packets can be picked up prior to race day on Monday,
September 15 from 10:00 AM - 5:00 PM at The
Chamber Jeffersontown.
ALL REMAINING PACKETS MUST BE PICKED UP ON
RACE DAY AT THE JEFFERSONTOWN PAVILION FROM
5:00 PM-6:30 PM
or download the form online at
www.jtownchamber.com/gaslightfestival.aspx .
Then mail the completed form to
The Chamber Jeffersontown- Attn: Gaslight 5K
10434 Watterson Trail Jeffersontown, KY 40299
Online: Visit www.active.com, and search for
2014 Gaslight Festival 5K to register online.
Age Groups:
0-14 15-19 20-24 25-29 30-34
35-39 40-44 45-49 50-54 55-59
60-64 65-69 70+
Wheelchair
Prizes
 Cash prizes to the top male and female finishers
 Awards to the top 3 finishers in each age group
 All will be eligible for the Grand Prize Drawing
For more information please contact:
The Chamber Jeffersontown
10434 Watterson Trail
Phone: (502) 267-1674
[email protected]
$5
$10
$15
$20
$25
$ ________
Preregistration: $20.00
$1
Would you like to make a donation to Kosair Charities?
Circle amount for donation & include total amount (registration + donation) with payment.
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Email
Sex
Age on Race day
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Date of Birth: ____ /____ /
Month / Day / Year
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Zip Code
State
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City
ADULT
KID
Phone Number
Address
Circle T-shirt Size
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First Name
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Last Name
Official Use
Only
YOU MUST SIGN WAIVER ON THE BACK OF THIS REGISTRATION
FORM. WE ENCOURAGE EARLY REGISTRATION TO AVOID LONG
LINES. Make checks payable to: Gaslight Festival 5K Run | Walk
Entry Fee: $20.00 if
postmarked by Sept. 2.
Late Entry Fee: $25.00
No refunds given.
Send check and this form to:
Gaslight Festival Run | Walk
10434 Watterson Trail
Jeffersontown, KY 40299
Or register online at www.active.com
Race #
2014 Gaslight Festival 5K Run | Walk
Tuesday, September 16
Registration fee for all applications
received, or postmarked by September 2, 2014.
Late Registration: $25.00
Registration fee for all applications received
AFTER September 2, 2014.
This includes registration the day of the event.
Event day registration is from 5:00 PM - 6:30 PM.
Any registration form received after
Tuesday, September 9 at 4:30 PM will
have to register the day of the event.
All participants will receive a Gaslight
Festival 5K Run | Walk t-shirt.
T-shirt size is not guaranteed to
late registrants.
Since 1923 Kosair Charities has had one primary
mission – helping children in need. Kosair
Charities knows that the
quality of a child’s tomorrow depends largely
on the quality of health,
medical treatment, &
support a child receives
AVAYA
today. That’s why over
Kosair Kid®
the years Kosair Charities
has given more than
$335 million to serve
thousands of children and provide them a second
chance at life. For more information visit
www.kosair.org or call 502.637.7696.
2014