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Ed Radice Memorial 5K Run and 1 Mile Family Fun Run January 11, 2020 Ed Radice Sports Complex 14720 Ed Radice Drive, Tampa, Fl. 7:30am Check In 8:30am 5K 9:30am Walk Cost $30 per person (5K) $15 (1 Mile Walk) $10 (t-shirt only) 5K Race will be chip timed All Runners and Walkers will receive t-shirt and medal Registration deadline : December 27, 2019 _____5K Race _____1 Mile Walk _____T-shirt Only _____Size—S, M, L, XL, XXL All Proceeds will benefit Friends of the County Parks FAMILY, FRIENDS, FUN, KINDNESS, LOYALTY, AND LOVE Name______________________________________ Age: ___________ Sex: M F Shirt Size _________________ Cell Phone_________________________ Emergency Contact_ __________________________Phone_____________________ Email Address:__________________________________________________________ Running Club: __________________________________________________________ Waiver (MUST BE SIGNED) In consideration of your accepting this entry, I, the below signed, intending to be legally bound, for myself, my heirs, my execu- tors and administrators, waive and release and any all rights and claims for damages I may have against the race, and sponsors and their representatives, successors and assigns for any and all injuries suffered by me in said event. I attest that I will partici- pate in this event as a footrace, that I am physically fit and sufficiently trained for the completion of this event. Furthermore, I hereby grant full permission to use my name and likeliness, as well as any photographs and any record of this event in which I may appear for any legitimate purpose, including advertising and promotion. Printed Name___________________________________________________________________ Signature_______________________________________________________Date___________________________ Solicitation Disclosure Statement: Registration #CH6738. A copy of the official registration and financial information may be obtained from the Division of Con- sumer Services by calling their toll-free number with the State. Registration does not imply endorsement, approval or recommendation by the State. Toll Free #1-800-435-7352. Website: www.FloridaConsumerHelp.com
