The Barbara Bartell Memorial 5K Runday

Saturday, May 23, 2015 at
8:30AM
Presents
CN Guidance and Counseling Services
The Barbara Bartell
950 S. Oyster Bay Road
Memorial 5K Runday
Hicksville, New York
ALL PROCEEDS BENEFIT CN GUIDANCE AND COUNSELING SERVICES, OFFERING MENTAL HEALTH, SUBSTANCE ABUSE AND
CHEMICAL DEPENDENCY COUNSELING TO INDIVIDUALS, GROUPS, AND FAMILIES.
THE COURSE
AWARDS
5K (3.1) Fast flat course. USATF
Sanctioned. Start and finish at 950 S.
Oyster Bay Road.
Trophies to top 3 Male and Female
Overall and Masters finishers. Awards for
the top 3 Male and Female finishers in
each age group, as well as, the top 3
ENTRY FEE
finishers in the Clydesdale/Athena and
$20 pre-entry until May 19th. $25 day of Wheelchair categories.
race. Teens under 16 half price if preRACE MANAGEMENT & TIMING
registered.
Race Director: Carl Grossbard
FUN RUN
Computerized scoring and timing by
Ages 12 & under. No Charge.
Elite Feats.
CHECK IN
Number Pickup & Late Entries on Race
Day 7:00 to 8:00AM. Fun Run 7:00 to
7:45AM.
SCHEDULE
5K Run Start 8:30 AM Sharp, Fun Run
start at 8:00AM Sharp
HOW TO REGISTER
Register online at active.com
Online registration closes at 11:59PM on
Tuesday, May 19, 2015.
Make check payable to “CNGCS” and
send to: CN Guidance and Counseling
950 S. Oyster Bay Rd., Hicksville, NY
11801
NOTE: EACH ENTRANT MUST FILL OUT AND SIGN A SEPARATE APPLICATION. PHOTOCOPY IS ACCEPTABLE. NO APPLICATION
ACCEPTED WITHOUT CHECK OR SIGNATURE. CALL (516) 822-6111 x265 FOR MORE INFORMATION.
Make checks payable to: CNGCS and mail to: CNGCS, 950 S. Oyster Bay Road, Hicksville, NY 11801.
NAME ____________________________________________________
I wish to make an additional contribution
ADDRESS _________________________________________________
of $5
$10
$15
$20
Other_______
CITY _______________________________ STATE ___________ ZIP ______________
EMAIL ___________________________________________ PHONE____________________________________
SEX ________ USATF # _______________________ DATE OF BIRTH _________________ AGE (on race day) _________
SPECIAL CATEGORY: WHEELCHAIR ______ CLYDESDALE/ATHENA: WEIGHT __________ FUN RUN: AGE:________
In consideration of your accepting this entry, I the undersigned, intending to be legally bound for myself, my heirs, executors, and administrators, waive and
release any and all rights and claims for damages I may have against CNGCS, Nassau County, The Town of Oyster Bay, Finish Line Technicians, Long Island Track &
Field and all race sponsors, their representatives, successors, and assigns, for any and all injuries suffered by me in said event. I attest and verify that I am physically fit, and have sufficiently trained for the competition of this 5K (3.1 mile) run, that I am aware of the considerable risks of competing in such an event, and
that my physical condition has been verified by a licensed medical doctor. Further, I hereby grant full permission to any and all of the foregoing to use any pictures, or any other record of this event for any purpose whatsoever. If signed by a parent, the parent agrees to release and hold the above organizations and
persons harmless of any claims and/or rights which may be asserted on behalf of the entrant.
SIGNATURE________________________________________ PARENTS SIGNATURE ___________________________________