Three Rivers 5K Fun Run/Walk For Health Complete for each participant:

Name:____________________________          M__ F__        Age on Race Day:______

Address:________________________  City:_______________ State:___ Zip _______

Phone:_________________          E-mail:____________________________________

Complete for each participant:

Please circle T-shirt Size                        S    M    L    XL    2XL                 Circle one: Run     Walk

Registration                   __ 1 Race $10                           __ 4 Races $25

You may also register online at sprunning.com (three days before event)

Races

__ March 27, 2010. Sharp Middle School, 35 Wright Road, Falmouth, KY

__ May 1, 2010. Owen County (location TBA)

__ May 8, 2010. Gallatin County (location TBA)

__ June 5, 2010. Gen. Butler State Park (back entrance), 1608 Hwy. 227, Carrollton, KY

All races begin at 9 a.m.   Same day registration will be available from 8 a.m. to 8:50 a.m.

**Mail-in entries must be post marked at least 1 week prior to event date. Online registration must be completed 3 days before the event.

Release of Responsibility

Runners must be careful to register and run under their proper name, sex and age division to

avoid disqualification. In consideration of accepting my entry, I, intending to be legally bound, hereby for myself, my heirs, my executors and administrators, do waive and release forever, any and all rights and claims for damages I may accrue against Three Rivers District Health Department, Steve Prescott, its agencies and the employees and agents of both involved with promoting and/or staging the race for any and all injuries suffered by me while traveling to and from and while participating in the Three Rivers 5K Fun Run/Walk for Health competition on the dates listed to the left. I further state that I am in proper physical condition to participate in this event. I also release publication rights to photographs of me shot during the Three Rivers “Run for Health” 5K/3.1 mile Fun Run/Walk for purposes of publicity for this and future Three Rivers events. Use of headphones is discouraged.

Name (print)__________________________

Signature_____________________________      Date:_________________

If under 18, signature of Parent/Guardian: _____________________________________

Make Checks Payable to:                                        Mail to: Attn: 5K Run/Walk for Health

Three Rivers District                                     510 South Main Street

                                                                                    Owenton, KY 40359

Three Rivers District Health Department