3rd Annual

Lisa's Lung Cancer Awareness 5K Run / 3K Walk

November 15, 2009
Lowell, Massachusetts


Time:	Walk: 11:00am Run: 12:00pm (Rain or Shine)
Place:	JJ Boomers, 724 Pawtucket Blvd, Lowell, MA
Distance:	5K Run 3K Walk
Entry Fee:	$20.00 per runner (prior to 11/12/09) $17.00 per walker $23.00 on race day Runners may register at JJ Boomers on Sunday, November 15, 2009 from 9:30am to 10:45am Pre-registrations are non-refundable and non-transferable.
Awards:	Given to top 3 in every age group (under 19, 20-29, 30-39, 40-49, 50-59 and 60-69, 70+)
Amenities:	Refreshments and food for walkers and runners, DJ David Woodard, raffles, indoor registration, bathrooms
T-Shirts:	First 250 entries (walkers or runners) will receive a t-shirt
Sponsors:	JJ Boomers Hair Studio 2000 Greystoke Painting Hookslide Kelly's Trinity (EMS) Owen & Ollie's Restaurant & Pub Jim The Carpet Guy Hello Heller Graphx Leominster Center for Technical Education
Timing:	Timing by 5K Sports
Contact:	Diane LeBlanc at PurpleGrape425@comcast.net

Mail-in Registration Form

Lisa's Lung Cancer Awareness 5K Run / 3K Walk

November 15, 2009

Make checks payable to:
Lung Cancer Awareness Run

Mail entry form to:
Lung Cancer Awareness Run
P.O. Box 7526
Fitchburg, MA 01420

FILL OUT THIS FORM, PRINT IT, SIGN IT, MAIL IT

Name:
Address:
City, State, Zip:
Daytime phone:
Email Address:
Date of birth:
Age on race date:
Circle your gender:	MALE FEMALE
Select your event:	5K Run 3K Walk
Circle t-shirt size:	S M L XL XXL
5K Run: $20.00 (per runner) ________ 3K Walk: $17.00 (per walker) ________ Additional Donation: ________ Total Enclosed: ________
Waiver must be read and signed before mailing: I know that running is a potentially hazardous activity. I should not enter or run this event 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 race including, but not limited to, falls, contact with other participants, the effects of weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your acceptance of my application, I, for myself and anyone entitled to act on my behalf, waive and release the event, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. All fees are nonrefundable. *Applications for minors are not accepted without parent/guardian signature
_______________________________ _____________ _____________________________________ Signature Date Parent's Signature if under 18 www.coolrunning.com is the complete online resource for runners.