THE ELLEN GORDON CPAs 4(a): CAUSE 5K RUN/WALK Friday, June 6, 2008 7:00 PM Wantagh Park, Wantagh, NY To benefit Island Harvest   PREREGISTRATION 5:30 PM RACE TIME: 7:00PM Awards: Trophies for Top 3 Overall Male and Female, Top 3 Finishers in each age category (10 year groups), All children under age 13 receive Ribbons, there will be Raffles, Prizes, Area Restaurant and other Gift Certificates, Music, and post race food refreshments Fee $15 until May 31, 2008, $20 thereafter. Race officially timed by Fit Results, Inc. Wantagh Park, Wantagh, Parking Field #1,entrance on Merrick Road, Wantagh:directions:www.glirc.org Events Take Wantagh Parkway to exit W6W Name ________________________________________________________________________________ Age on race day _______________ Birth date / /__ Sex (M/F)_____________ Phone ( ) E-mail__________________________ Address ______________________________City___________State______Zip Code _______ WAIVER AND RELEASE I AM A RUNNER ___ I AM A WALKER___ 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, 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 New York State Society of Certified Public Accountants, Island Harvest, the County of Nassau and all sponsors, Race Directors, their agents, servants and volunteers, their representatives and successors from all claims of 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. I acknowledge that entry fees are non-refundable for any reason and that my right to participate in this event (or a rescheduled event if this event is cancelled) is non-transferable. Roller Blades, Baby Joggers, Headphones, Animals are prohibited from participating in this race. Signed Name: _______________________________________________________________________________________________________________________ Applicant’s Signature (Parent or Legal Guardian’s if applicant is under 18) Date q Enclosed is my registration fee of $15 payable to Island Harvest q Enclosed is my additional tax deductible donation of $______ payable to Island Harvest RETURN BY MAY 31St AND SAVE! DAY OF RACE REGISTRATION FEE $20 Mail sponsor forms & checks to The Ellen Gordon CPAs 4 (a): Cause, c/o John Barone, Weiser LLP 3000 Marcus Ave. Lake Success, NY 11042 (or bring to the Registration Table at the Race) Questions? John Barone at(516) 620-8508 or e-mail:jbarone@weiserllp.com Or Roy B. Massa (631) 897-7182 or e-mail: roymassa@yahoo.com Home of The Trusted Professional 3 park avenue, new york, ny 10016-5991 212.719.8300 • fax 212.719.3364 www.nysscpa.org