FAMILY REGISTRATION FORM Fill the Ark 5K & 1-Mile Walk May 31, 2014 - 8AM

3103 Craig Dr. - Wasatch Jr. High north field

"Fill the Ark 5K" is a non-profit community organization sponsored by East Millcreek community volunteers and businesses. All proceeds are donated to Heifer International - www.heifer.org - to fill an "Ark" full of animals for needy villages worldwide. Pre-registration fee: $40 per family; Day of Race Registration Fee: $50 per family

Please complete the Registration Form and the Race Waiver Release section for each participant.

Return with check by mail to: "Fill the Ark" - c/o Mark Olson 2939 Brookburn Rd. SLC, UT 84109 - by May 24, 2014

Last Name: Address: City, State, Zip: Email: Emergency Contact:

First Name:

Contact Phone:

Phone:
Fee does not include T-shirt

Age

Gender

FAMILY REGISTRATION

Event

T-Shirt Size

Name

5K

1M YXS YXS YXS YXS YXS YXS YXS YXS YS YS YS YS YS YS YS YS YM YM YM YM YM YM YM YM YL YL YL YL YL YL YL YL S S S S S S S S M M M M M M M M L L L L L L L L XL XL XL XL XL XL XL XL

$5 per T-shirt

Family Pre-Registration Fee: Day of Race Family-Registration Fee: T-shirts: Sub Total:

$40.00 $50.00

I will be unable to Run or Walk in the event, but here is my tax-deductible contribution to "Fill the Ark" Please make check payable to: "FILL THE ARK 5K"

Total Amount of check: $

5K RACERS ONLY: Check this box if you DO NOT WANT to be timed and have your name listed in the Race Results!
RACE WAIVER & RELEASE: I waive and release from all liability of the sponsors and organizers of the Fill the Ark 5K Run / Walk; and all volunteers and support people associated with the Run/Walk for any injury, illness, or mishap that may result from participation in the event. I attest that I am sufficiently trained for my level of participation. I also give my permission for the free use of my name and pictures in broadcasts, newspapers, and event publications. I understand that the entry fees are non refundable. If the race is canceled due to inclement weather, it may or may not be rescheduled.

Signature (or Guardian Signature for minor)

Date

Print Name Here

INDIVIDUAL REGISTRATION FORM

Fill the Ark 5K & 1-Mile Walk May 31, 2014 - 8AM
3103 Craig Dr. - Wasatch Jr. High north field "Fill the Ark 5K" is a non-profit community organization sponsored by East Mill Creek community volunteers and businesses. All proceeds are donated to Heifer International - www.heifer.org - to fill an "Ark" full of animals for needy villages worldwide.

Please complete the Registration Form and the Race Waiver Release section for each participant.

Return with check by mail to: "Fill the Ark" - c/o Mark Olson 2939 Brookburn Rd. SLC, UT 84109 - by May 24, 2014

Last Name: Address: City, State, Zip: Email: Emergency Contact:

First Name:

Contact Phone:

Phone:

Age

Gender

INDIVIDUAL REGISTRATION
Name

Event

T-Shirt Size

Pre Reg: 5K $20 T-shirt Included

Day of 5K $25 T-shirt included

1M Run or Walk $5 donation T-shirt *NOT included

5K 1M YXS YS YXS YS YXS YS YXS YS YXS YS YXS YS YXS YS YXS YS YM YM YM YM YM YM YM YM YL YL YL YL YL YL YL YL S S S S S S S S M M M M M M M M L L L L L L L L XL XL XL XL XL XL XL XL Sub-Total: $

$5.00 per T-Shirt

I will be unable to Run or Walk in the event, but here is my tax-deductible contribution to "Fill the Ark"

Please make the check payable to: "FILL THE ARK 5K"

Total Amount of check: $

5K RACERS ONLY: Check this box if you DO NOT WANT to be timed and have your name listed in the Race Results! RACE WAIVER & RELEASE: I waive and release from all liability of the sponsors and organizers of the Fill the Ark 5K Run / Walk; and all volunteers and support people associated with the Run/Walk for any injury, illness, or mishap that may result from participation in the event. I attest that I am sufficiently trained for my level of participation. I also give my permission for the free use of my name and pictures in broadcasts, newspapers, and event publications. I understand that the entry fees are non refundable. If the race is canceled due to inclement weather, it may or may not be rescheduled.

Signature (or Guardian Signature for minor)

Date

Print Name Here