Register online or print this aplication and mail to: Christopher’s Run 1st Annual 5K Run/Walk In Memory of Christopher Lesta REGISTRATION FORM DAY: SATURDAY, 06/14/08 TIME: 9:30AM LOCATION: AGAWAM PARK, SOUTHAMPTON ------------------------------------------------------------------- ENTRY FEE: · $25.00 for Pre-Registered Participants · $30.00 after June 1, 2008 RACE DAY REGISTRATION FROM 8:15-9:15AM AT THE SOUTHAMPTON CULTURAL CENTER (NEXT TO AGAWAM PARK) Age Groups: 14 and under, 15-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80-89 Awards: Top male and female overall and first three in each age group. PLEASE COMPLETE: NAME ____________________________________________ [ ] M [ ] F; Birth Date____/____/____; Age on Race Day_________ ADDRESS __________________________________________________________________________________________________ CITY / STATE / ZIP __________________________________________________________________________________________ PHONE NUMBER _________________________________ EMAIL ADDRESS _____________________________________________ Waiver: I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running in this event including, but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, dehydration, traffic, ice and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Village of Southampton, the East End Road and Trail Runners Club, all sponsors, Race Directors, their agents, servants and volunteers, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, and any other record of this event for any legitimate purpose. MAIL COMPLETED “CHRISTOPHER’S RUN” APPLICATION AND CHECK TO: EER & TRC, C/O Bob Beattie, 4295 Noyac Road, Unit 1, Sag Harbor, NY 11963. Please make checks payable to: The Christopher Lesta Fund. Signature__________________________________________________________________________________________________ (If under 18, signature of parent or legal guardian is required). Race Timed by Island Timing ~ Island Timing uses the Winning Time Chip: The Winning Time Chip must be worn around your ANKLE. Failure to do so will exclude you from the results. Wear your bib number with pull tag on your front. Do not pin the big hole. The Winning Time Chip is on loan to you and remains the property of Island Timing. The chip must be returned at the finish line or you will be charged an additional $20.