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NEW SUFFOLK WATERFRONT 5K
Saturday, August 15, 2009 10:00am (rain or shine)
Register Online at Active.com
THE PLACE The water’s edge of New Suffolk Avenue, New Suffolk.
LIE east to last exit-73, east on Rt. 58, which turns into Rt. 25, make a right on New Suffolk Avenue. Follow all the way to the water where parking attendants will be present.
5 K REGISTRATION $20.00 for pre-registration, $25.00 day of event registration
*Timing chips and standings provided by Island Timing
Awards: Top Male & Female overall, Top 3 in each category
Mail pre-registration form and check made out to New Suffolk Waterfront Fund to :
New Suffolk Waterfront Fund, PO Box 146, New Suffolk, New York 11956, ATTN: Gary Osborne
(917) 861-3014 * www.peconiclandtrust.org/new_suffolk
REGISTRATION FORM
Pre-register by AUGUST 1st and receive a cool FREE T-SHIRT
THE EVENT New Suffolk Waterfront Fund & The Peconic Land Trust host a 5K run/walk followed by food, entertainment and a kayak paddle in Cutchogue Harbor. Some kayaks are provided.
RUN / WALK
Name CIRCLE ONE: Run Walk
CIRCLE one Age Group: 12 & under 13-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89
Age_____ Birthdate___________ Gender M or F
Mailing address_______________________________________Town___________Zip__________
Email address_________________________________________________________
Total Donation $_____________ Shirt Size: (adult size) SMALL MEDIUM LARGE X-LARGE
THE TIME 8:30am Registration opens; 5K Run / Walk 10:00am sharp.
Assumption of risk, release & waiver of liability, and indemnity agreement
In consideration of my participating in the New Suolk Waterfront 5K Run / Walk 2009, I represent that I understand the nature of the event and that I am quali-ed, in good health, and in proper physical condition to participate in such event. I fully understand that the event involves risks of serious bodily injury, permanent disability or death which may be caused by 1) my own actions, 2) those actions of others-including “Releasees”, 3) the event conditions or 4) risks not known to me at this time. I fully accept and assume all such risk and all responsibility for losses, costs, and damages I may incure as a result of participation in this event. I hereby release, discharge and agree not to sue New Suolk Watterfront Fund , The Peconic Land Trust, any participating sponsors, Town of Southold, the Village of New Suolk, their respective directors, o cers, agents volunteers, other participats, employees, advertisers and landowners (all considered (”Releasees”) from all liability, claims, demands, losses, or damages I may incur as a result of participation in this event, whether cause in whole or in part by the negligence of the Releases, including negligent rescue operations. I further agree to indemnify, save an dhold harmless each of the Releasees from any loss, liability, damage, or cost (including reasonable attorney’s fees) which they may incur as a result of anyone making a claim on my behalf. I understand that if one part of this agreement is invalid, all other parts will remain valid to the extent of the law. I have read this unconditional Agreement fully; understand it and the rights I’ve waived by signing it voluntarily.
Printed name of participant__________________________________________________ Date:____________________________
Signature of participant______________________________________________________________________________________
Printed name of parent or guardian____________________________________________ Date:___________________________
Signature of parent or guardian_________________________________________________________________________________
Participants under the age of 18 must receive parent / guardian permission to participate.
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