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1st Annual Jimi Gubelli - 5K Walk/Run
Saturday, June 27th, 2009
TO BENEFIT JIMI GUBELLI COLLEGE SCHOLARSHIP AWARD
Island Park, NY 11558
Description: 5K Walk/Run through scenic Island Park, rain or shine.
When: Saturday, June 27th, 2009 at 10:00 am (check-in from 7:30 am- 9:00 am).
Where: Island Park Beach, Island Park - entrance is on Waterford Road off Long Beach Road.
Entry Fee: Pre-registration: $25.00 - Post-registration: $30.00 (Postmarked after June 17th).
Make checks payable to: Island Park Civic Association
Mail to: I.P.C.A., PO Box 241, Island Park, NY 11558
Contact: Anthony D’Esposito: 516.695.3646; email: jimigubellifndn@aol.com
Rich Colon: 516.315.0636; email: jimigubellifndn@aol.com
Amenities: All pre-entered runners will receive t-shirts and a goody bag. Water and restrooms available at
check in. Multiple aid stations available on the course. Computer scoring and results sent out
after the race. Post Race Party with food and drink will be available after the race.
Awards: First three overall male and female, first three male and female 14 & under, 15-19, 20-29, 30-39,
40-49, 50-59, 60-69 and 70 & over.
Packet P/U: June 26th, from 5pm – 8pm, Island Park Beach under the Gazebo or Race Day, June 27th, from 7:30 a.m. to 9:00 a.m. under the Gazebo.
PLEASE NO STROLLERS, NO DOGS, NO ROLLER BLADERS, NO SCOOTERS AND NO BICYCLES.
ENTRY FORM
Send entry form with check payable to: ISLAND PARK CIVIC ASSOCIATION
Mail To: I.P.C.A., PO Box 241, Island Park, NY 11558
Fee: $25.00 before June 17, 2009 - $30.00 after June 17, 2009
First Name: ______________________________________ Last Name: _________________________
Address: _____________________________ City: ___________________ State:______ Zip:________
Phone Number: _________ ___________________ E-mail: ___________________________________
Gender: __________ Age: _____________ Date of Birth:_________________ T-Shirt Size:__________
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(Parent or guardian if under 18 years old)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 included but not limited to falls, contact with other participants, the effect of the weather, traffic and the conditions of the road, all such risks being known and appreciated by me. In consideration for my entry I do hereby for myself, and anyone entitled to act on my behalf, waive and release the Island Park Civic Association, its affiliates and subsidiaries, The Jimi Gubelli Foundation and all sponsors, agents and representatives or assignors for any and all damages sustained and suffered by my connection with, my association with or entry in the race. |
Signature: ___________________________________________ Date: ___________________________
Event Hosted by the Island Park Civic Association
