Ap dash flyer and registration form

@ 6pm, May 2nd, 2015
Horizonation
Master
Sub.
No.
A
p
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Registration starts: 3/20/2015
$20.00 w/o T-Shirt (by 5/1/2015)
$25.00 w/ T-Shirt (by 4/15/2015)
$30.00 (race day)
PayPal options available w/ $1.03 fee
Email: [email protected] for a registration
form and payment options
Ap Dash 5K
5/2/2015 @ 6 pm
Sponsored by the Soil & Water Conservation Society
The race will be at the University of Illinois arboretum. Parking is limited but is free on the street and at
the parking lots at the arboretum.
PACKET PICK UP: 5/1/2015 at the student union near Espresso Café
from 5-8pm or on race day starting at 5pm
Water, Gatorade, and post race refreshments will be provided
PLEASE COMPLETE THE FOLLOWING FORM AND
1) either email back to [email protected] or
2) mail it to 1816 S. Oak St., Champaign, IL 61820 Attn: Jenwei Tsai before 4/15/2015 or
3) drop it off at the NRES main office on the 5th floor @ Turner Hall
PAYMENT OPTIONS:
1) Using PayPal search for our email address above (please add $1.03 processing fee)
2) Check payable to: Soil & Water Conservation Society U of IL Student Chapter
-------------------------------------------------------------------------------------------------------------------------------------FIRST NAME____________________LAST NAME________________________________________
STREET ADDRESS_____________________________________________________
CITY______________________________________
STATE____________________________zip____________
DATE OF BIRTH mm/dd/yy _______/_______/________
SEX (CIRCLE ONE) M
F
SHIRT SIZE (CIRCLE ONE) YS YM S M L XL XXL (add $1.50)
ENTRY FEES:
$20.00 without T-shirt (by 5/1/2015)
$25.00 with T-shirt (by4/15/2015)
$30.00 on RACE DAY
PLEASE READ AND SIGN THE PARTICIPATION WAIVER BELOW
I know that running for a race is potentially hazardous activity, which could cause injury or death. I will not enter and
participate unless I am medically able and properly trained, and by my signature, I certify that I am medically able to
perform this event, and am in good health, and I am properly trained. I agree to abide by any decision of a race official
relative to any aspect of my participation in this event, including the right of any official to deny or suspend my
participation for any reason whatsoever. I assume all risks associated with running in this event, including but no limited
to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the
conditions of the road, all such risks being known and appreciated by me. I understand that bicycles, skateboards, baby
joggers, roller skates or roller blades, animals, and headsets are not allowed in the race and I will abide by this guideline.
Having read this waiver ad knowing these facts and inconsideration of your accepting my entry, I, for myself and anyone
entitled to act on my behalf, waive and release the Ap Dash 5K, the city of Urbana, the Soil and Water Conservation
Society, University of Illinois at Urbana-Champaign, and all sponsors, their representatives and successors from all claims
or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence
or carelessness on the part of the persons named in this waiver.
Signature (parent or guardian required if under 18) ______________________________________________________
Date_________________________________________________
Questions? Please e-mail: [email protected]