2009_NN-App Inside

Sponsors & Donors
REGISTRATION FORM
(Of walker/runner____________________)
Name
Phone #
Amount
First Name:
1. ________________________________
Address:
2. ________________________________
3. ________________________________
City:
4. ________________________________
Age:
5. ________________________________
Phone:(
6. ________________________________
7. ________________________________
8. ________________________________
9. ________________________________
10. _______________________________
11. _______________________________
12. _______________________________
13. _______________________________
14. _______________________________
In lieu of registration fee, race participants
may seek sponsors. A minimum of $100
must be collected and turned in prior to the
race start.
Make checks payable to:
Domestic Abuse Shelter
Last Name:
State:
Date of Birth:
)
Male:
Zip Code:
Female:
Email:
T-Shirt Size: S M L XL
(Circle One)
WALKER RUNNER
(Circle One)
I know that running/walking are potentially dangerous activities. I should not enter the run/walk
unless I am medically able and properly trained. I agree to abide by the decision of a race official to
my ability to safely complete the run/walk. In consideration of being accepted, I hereby assume all
risks arising out of this event and release and hold harmless the sponsors, officials, volunteers,
administrators and all other persons associated with the DAS Run/Walk, including Key West
Southernmost Runners Inc., County of Monroe, from any and all liability claims, or causes of action
of every kind and nature arising out of or relating to my participation in its event. I authorize officials
of the run/walk to use their discretion to have me transported to a medical facility and take full
responsibility for this action. I grant full permission to any and all of the foregoing to use any
photography, videotapes, motion pictures, recording or any other record of this event for any
purpose. I further understand that my entry fee in nonrefundable. PETS, BIKES, SKATES,
SKATEBOARDS, ROLLERBLADES & HEADSETS ARE PROHIBITED ON THE COURSE
DURING THE RACE. NO ONE MAY ENTER THIS EVENT WITHOUT SIGNING THIS
OFFICIAL WAIVER.
Signature of Entrant
Date
Signature of Parent or Legal Guardian (if under age 18)
Date
P.O. Box 522696
Marathon Shores, Fl. 33052
Eighth Annual No Name Race
D omestic Abuse Shelter, I nc.
(Check One)
Payment:
Bib Number:
Eighth Annual
No Name Race
5K Walk/Run
Saturday, February 28, 2009 8am
At the Big Pine Key Old Wooden
Bridge Fish Camp
No Name Race
Sponsors
Eighth Annual
No Name Race
5K Walk/Run
Big Pine Key, Florida
Saturday, February 28th, 2009
8am
Sponsored by
The Domestic Abuse Shelter, Inc.
www.domesticabuseshelter.org
Coordinated by
Key West Southernmost Runners Club
www.southernmostrunners.com
Course:
out Watson Rd., over the bridge to No Name Key
and back.
Parking: Old Wooden Bridge Fish Camp, at No Name Rd.,
and No Name Bridge
Registration and packet pick up:
Fri. Feb. 27th, 4-7 PM at Big Pine Winn Dixie
Sat. Feb. 28th, 6:30 am on site
Awards: Runners: 1st. OA M&F 1st OA Masters M&F
14 & under, 15-19 M&F 2 deep in 10 year age
groups through 70+ Walkers: 1st. OA M&F, 2 deep in
10 Year age groups
Celebrate: Domestic Abuse Shelter post race celebration
refreshments and prizes donated from local businesses
Proceeds: Support Domestic Abuse Shelter
$20 registration in advance $25 on site.
DAS Member registration $15 in advance
$25 on site.
Children under 15 registration $10
Call for more information
the DAS at (305) 743-5452
Make checks payable to Domestic Abuse Shelter
& mail with registration form to:
P.O. Box 522696
Marathon Shores, Fl. 33052
Jim Rutherford
Construction & Remodeling , LLC
Oropeza & Parks, CPA’s
Theater of the Sea
Sherry Phillips
Law Offices of Hal Schuhmacher,
Amoray Dive Resort
TIB Bank
Out of The Blue Gallery & Gifts
Roberta Castillo, REALTOR
The Weekly Newspapers
Centennial Bank Hospitality Wagon
SPONSORED BY
THE DOMESTIC ABUSE SHELTER
AND
KEY WEST SOUTHERMOST RUNNERS
OLD WOODEN BRIDGE
FISH CAMP
ON BIG PINE KEY