2009 Race Results
Saturday, May 16, 2009 (Rain or Shine)
Register online at Active.com
R E G I S T R A T I O N F O R M
Pre-register by Friday, May 1, 2009 to receive a T-shirt
What The East End’s Premier Older Americans Month Celebration
5K Race on the Peconic Landing Campus–
followed by BBQ lunch & Caribbean music!
Time 8:00 a.m. registration opens, 5K Race 9:30 a.m.
Place Peconic Landing Campus • 1500 Brecknock Road, Greenport
5K Race Registration $20.00 for pre-registration, $25.00 day of event registration
***Timing chips and final standings provided by East End Runners
Awards: Top Male & Female overall, Top Male & Female Seasoned Runners and first 3 in each age group
"_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Name _________________________________________
Circle one Age Group: 14 and under 15-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89
Age Birth date Gender
Mailing address
Email address ____ Phone number ______________________
Total donation $ ___________ Shirt size: (adult sizes) q Small q Medium q Large q X-Large
Assumption of risk, release & wavier of liability, and indemnity agreement
In consideration of my participating in the 2009 May Mile and Peconic Landing 5K, I represent that I understand the nature of the event and that I am qualified, 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 incur as a result of participation in this event. I hereby release, discharge and agree not to sue Peconic Landing, Town of Southold, and Village of Greenport, their respective directors, officers, agents, volunteers, other participants, employees, sponsors, 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 and hold 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.
*** 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.
Printed name of participant______________________________________________ Date: _______________________
Signature of participant _______________________________________________________________________________
Participants under the age of 18 must receive parent/guardian permission to participate.
Printed name of parent or guardian ______________________________________ Date: _______________________
Signature of parent or guardian ________________________________________________________________________
Mail pre-registration form and check made out to Peconic Landing to:
Peconic Landing, 1500 Brecknock Road, Greenport, NY 11944, ATTN: Debbie O’Kane
(631) 477-3800 ext. 241 • www.peconiclanding.org
