TALC Dollars for Scholars Revised Flyer 2015 (2).pub

The Teachers Association of Lee County Offers
The 2nd annual
Dollars for Scholars
5K Run/Walk
Saturday, April 25, 2015 at 6:00 p.m.
Rotary Park, The Rose Garden, Cape Coral, FL
REGISTRATION:
____ Runner
Last Name:_____________________
____ Walker
First Name:_______________________
Mailing Street Address: ____________________________________________________
City: ____________________ State:_________
Birthday: _____/_____/__________
Age: ________
Zip Code:_______________
Circle One:
Male
Female
All proceeds benefit
the TALC Scholarship
Fund offering
scholarships to local
students of TALC
members.
E-Mail Address:_______________________________________
T-Shirt Size (Circle One) Adult S M L XL 2XL 3XL Youth S M
(Shirt guaranteed for all participants registered by April 18, 2015
_____ Early Pre‐Registered Adult (18 and over) ($20)
_____ Early Pre‐registered Lee County Teacher ($15)
_____ Early Pre‐Registered Youth (under 18) ($10)
_____ A er April 18, 2015, all ages ($25)
_____ Cheer from the Couch Dona on ($20)
Awards:
Registra on
also
available at
Ac ve.com
Fee _______________= Total Due$________________
Checks Payable to: TALC (Teachers Associa on of Lee County)
Mail Entry with Check to c/o The Run Shoppe, 1407 Cape Coral Pkwy E
Cape Coral FL 33904
Male and Female ‐ Top Overall, Masters,
Grand Masters, & Senior Grand Masters.
Top 3 in each age group. Age divisions:
Male and Female 10 & under, 11‐14, 15‐19,
20‐24, 25‐29, 30‐34, 35‐39, 40‐44, 45‐49,
50‐54, 55‐59, 60‐64, 65‐69, 70+
+ SCHOOL PARTICIPATION CHALLENGES
Waiver of Liability
Release form is mandatory. Incomplete or unsigned entry form cannot be accepted.
The race will be run rain or shine, no refunds please. Due to the nature of the course and for the safety of all par cipants, unregistered par cipants,
unauthorized vehicles, bicycles, roller blades/skates, skateboards, strollers, headphones and pets are strictly discouraged. If you disregard these
restric ons, you are increasing risk of injury to yourself and others and are assuming full responsibility for all injuries. Hot and humid condi ons may
exist; drink plenty of fluids before and a er the race. In considera on of the acceptance of this entry, I release from their own negligence, the Teach‐
ers Associa on of Lee County, 3D Racing, The Run Shoppe, race officials and mers and all individuals any way connected with this event, from any
injury or illness I may sustain during my par cipa on in this event or which in any way is associated with this event. I a est that I am physically fit
and I have trained sufficiently for the comple on of this event. I a est that I am informed of the dangers of running in hot and humid weather.
_______________________________________________________
__________________________________
Signature of runner/walker or parent/guardian of those under 18
Date