TO BENEFIT: The Pediatric Dental Fund of the Hamptons, Inc.
Pediatric Dental Fund of the Hamptons (PDF) is a 501(c)3 not-for-profit organization whose sole purpose is to provide affordable, preventive and acute dental care to East End children in need.
GIANT STEPS 5K RUN/WALK: AGES: 10-80
ENTRY FEE: $20 Adults/$10 Children 12 & under/$15 Seniors
$25 day of race registration
*No Dogs, Rollerblades or Bicycles
RACE LOCATION: Amagansett Fire Department, Main Street, Amagansett. NY 11930
Take Route 27 East through the Village of Amagansett. The Amagansett Fire Department is on the left at the end of the village.
SPONSORED BY:
Whitmore’s Landscaping, East Hampton Healthcare Foundation, L. W. Winslow Painting, Inc., Round Swamp Farm, Gubbins Running Ahead, Colgate Foundation, Amagansett Fire Department, and Goldberg’s Bagels.
RACE DIRECTOR: Howard John Lebwith FOR MORE INFORMATION CONTACT: Pediatric Dental Fund @ 631-329-6828
AWARDS: Top Overall Male/Female Trophy: 1st, 2nd, 3rd. Top Three in each category, Male/Female. “T” shirts to first 50 runners.
This is my application for the 2009 GIANT STEPS run/walk to be held Sunday, July 26, 2009. The race begins and ends near the Amagansett Fire Department, starting at 9 AM sharp. I understand that the footrace will be 5K in length, and in consideration for your accepting an application, I agree to release any and all rights and claims I may have against the Town, Village, the Fire and Police Departments, successors, sponsors and volunteers of the race from any responsibility for injury or liability that might occur from my entry. Further, I hereby grant full permission to any and all of the foregoing to use any photographs, video tapes, motion pictures, or recordings of this event for any purpose whatsoever. I affirm that all information below is true and correct and understand that if proved false, my entry could be disqualified. I warrant that I am in excellent physical condition and wish to enter the run in the following category:
PLEASE CHECK ACCORDINGLY: #__________________
Runner _____ Walker ____
Male ____ Female ____
Age _______ (write in your age and circle the category below) Date of Birth:__________
· 10-12 · 13-19 · 20-29 · 30-39 · 40-49 · 50-59 · 60-69 · 70-79 · 80+
Name _________________________________________________________________________
Mailing Address __________________________ City ____________________ State ____ Zip _________
Phone: (H) _________________________ (W) ______________________
E-Mail Address: _____________________________ How did you hear about us? __________________
SIGNATURE: __________________________________________
(Signature of Parent or Guardian if Runner is under age 18)
Please tear off and mail this coupon, along with your check payable to Pediatric Dental Fund of the Hamptons, to:
PEDIATRIC DENTAL FUND OF THE HAMPTONS, POB 2675, EAST HAMPTON, NY 11937