2015 Glow Trot 5K new form


2015 Glow Trot 5K new form
Friday, May 15, 2015
University of North Georgia
Gainesville Campus
3820 Mundy Mill Road
Oakwood, GA 30566
I mile Fun Run and Walk at 8:00pm • 5K Run and Walk at 8:30pm
Registration Starts at 6:00pm - Awards at 9:30pm
$25 before April 25, 2015 ($30 after April 25, 2015)
Registrations accepted up to start of race
Each entrant registered prior to April 25, 2015 will be guaranteed a t-shirt with “glow in the dark ink” and a
glow in the dark item. All participants who register after April 25, 2015 or on race day will be first come at
race site until t-shirts and glow items are gone. Glow in the Dark shoe laces are available for an additional
$3.00 per pair. Shoe Laces must be pre-ordered.
Overall Male and Female, Over all Masters and Grand Masters, Male and Female, and top 3 males
and females in five year age categories starting at 10 and under and going to 70 and over.
Team Spirit Award
Most Participation Award
Register online at
Mail entry form and fee no later than April 25, 2015 to
American Cancer Society, 2565 Thompson Bridge Road, Suite 114, Gainesville, GA 30501
After April 20, 2015 bring entry form and fee to race day or American Cancer Society Office
NAME ____________________________________________________MALE_____ FEMALE_____
Glow in the Dark Shoe Laces ($4.00 per pair) __________ Pair(s)
ADDRESS _________________________________________________CITY ___________________
STATE ________ ZIP_____________ PHONE (
) ________ - ____________________________
All proceeds benefit the American Cancer Society
Relay For Life Hall County, in hopes of finding a CURE!
Together with our millions of supporters, the American Cancer Society saves lives and creates
more birthdays by helping people stay well and get well, by finding cures and by fighting back!
Relay For Life is the American Cancer Society’s signature event. Relay represents the hope
that those lost to cancer will never be forgotten, that those who face cancer will be
supported, and that one day, cancer will be eliminated. It offers everyone in the community
the opportunity to participate in a worldwide movement to end cancer.
The money raised by the American Cancer Society’s Relay For Life goes to fund
the research, education, advocacy and patient Services.
For more information on the Relay For Life of Hall County
Log on to www.relayforlife.org/hallga
From I85 - Exit 129, go West on Highway 53. Go 11.4 miles and the University of North Georgia will
be on your right. Traveling North From 985 take Exit 16, turn left. Traveling South From 985 Take Exit
17 keep left to Oakwood exit turn right.
[email protected] or 770-297-1220
In consideration of acceptance of this entry I waive any and all claims for myself and my heirs against American Cancer
Society Relay For Life, University of North Georgia, Race Officials and Sponsors of the Glow Trot 5K for illness or Injuries
which may result, directly or indirectly, from my participation. I assume any and all risks associated with running in this
Race, included but not limited to: injuries, falls, contact with other participants, contact with traffic, road conditions, course
conditions, items dropped on the course, slipping and falling on water or other substances or items, effects of hot weather,
effects of cold weather, effects of humidity, storms, winds, lightening, and all other risks known and appreciated by me.
Having read this waiver, I, for myself and anyone entitled to act on my behalf, waive and release the American Cancer Society, Relay For Life Hall County, University of North Georgia, Race Officials, Sponsors, all city, county and state governments , their representatives and successors, from all claims or liabilities of any kind arising out of my participation in this
event. I grant permission to contact by email for race related communications. I understand that all entries are final with no
refunds, The official race director reserves the right in any event of emergency or local or national disaster to cancel the
race or to change the day and or time to another date. In the event of cancellation or change, there is no refund of entry
fees. I further state, that I am in proper physical condition to participate in this event.
SIGNATURE ____________________________________________________________________ DATE _____________
If you are registering a child under the age of 18 or an incapacitated adult, you represent and warrant that you are the parent or legal guardian of the that party and have the legal authority to enter into this agreement on their behalf and, by proceeding with this event registration, you agree that the terms of this Agreement and Waiver shall apply equally to all Registered Parities. By registering a child under 18, you agree and consent to the collection of that child’s information which you
provide for the purposes of registration.
UNDER 18 PARENT’/GUARDIAN SIGNATURE ________________________________________DATE ______________