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Compassion 5K Run and 1 mile Fun Run/Walk REGISTRATION FORM

NHC Scott 2nd Annual

Name:________________________________

Compassion 5K Run and 1 mile Fun Run/Walk

Address:_______________________________ City:_______________________ State:______ Zip:________ Phone:____________________ Email:_________________________________ Gender: M F Age:_________ DOB:____________________ Please circle: 5K Run

1 mile Run/Walk

T-Shirt size: S M L XL Youth sizes: S M L XL Long-Sleeved T-shirts are GUARANTEED to persons who pre-register by 9/16/11. Additional shirts may be available Race Day or can be picked up at NHC Scott 2 weeks after race.

The roads are always open...

Saturday, October 8, 2011 Race starts at 8:00 a.m. Race Day Registration 7:00 a.m.

ENTRY FEE

$15 if pre-registered by 9/16/11 $20 Race Day Mail Registration and Check to: NHC Scott Attn: Casey Willis P.O. Box 767 Lawrenceburg, TN 38464 Make Checks payable to: NHC Scott/TFGE

Location: Lawrence County HS NHC Scott

2380 Buffalo Road Lawrenceburg, TN 38464 (931) 762-9418

(Gymnasium behind school)

1800 Springer Road Lawrenceburg, TN 38464 The 5K course is nationally certified. USATF #TN10074MS


Why should I participate???

5K Awards

Overall Male and Female Top two Male and Female finishers in the following age groups:

The Foundation for Geriatric Education

0-4 10-14 20-24 30-34 40-44 50-54 60-64 70-74

5-9 15-19 25-29 35-39 45-49 55-59 65-69 75+

TFGE is an independent organization committed to the funding and promotion of increased education for health care professionals specializing in geriatrics. In its support of this increased education in geriatrics, the Foundation makes every effort to raise money which health education programs that teach must have if they are to develop or further enhance their geriatric curricula. Local Funds raised for TFGE in the past and this race will be used to support programs such as Columbia State’s healthcare programs, Tennessee Technology Center LPN Program, Martin Methodist College BSN Program, training healthcare workers through seminars at UNA and other institutions, local health student scholarships, and more!

Release and Waiver I know that running a road race is a potentially hazardous activity. I should not enter a run unless I am medically stable and properly trained. I agree to abide by any decisions of a race official relative to safely completing the run. I assume all the risks associated with running/ walking in this event including high heat and/or humidity, traffic and other road conditions, all such risks being known and appreciated by me. Having read this waiver and knowing those facts, I, individually, (and/or parent/guardian of minor) for and in consideration of acceptance of this entry in the Compassion Run Event, do hereby release, remise, waive, and forever discharge NHC Scott and The Foundation for Geriatric Education and its officers, directors, agents, volunteers, and employees, the City of Lawrenceburg and Lawrence County High School, and all affiliates, sponsors, and representatives and successors from all claims of liabilities of any kind arising out of participation in this event. I grant permission to use photographs, motion picture recordings, or any records of this event for legitimate purposes such as marketing and event promotion. Signed:_______________________________

TFGE is a 501(c)3 organization and contributions above and beyond race day registration fee are tax-deductible. You will receive a receipt and tax information for any contribution above the registration fee.

Questions please contact:

(Parent or Legal Guardian signature if under 18)

Casey Willis (931) 762-9418 or cwillis@nhcscott.com or Loree Hall (931) 201-6963 or loreehall@gmail.com

Date:_________________________________


2011 Compassion 5K