Click here for the PDF entry form

The 1st Annual

Miles for Matt Foundation Celebrate Life 5K Run/Walk Saturday, May 31, 2014

8:00 am Cedar Creek Park

Merrick Road east of Wantagh Avenue, Seaford, NY

Post Race Ceremony, Refreshments

COURSE: 5K (3.1 miles) course inside Cedar Creek Park, 3340 Merrick Road, Seaford

Packet Pick-up: Runner’s Edge, 242 Main Street, Farmingdale Friday May 30th 1pm—6pm or Race Day at Cedar Creek Park from 6:45 am—7:45 am

AWARD CATEGORIES: Top 3 overall male and female; Top 3 Finishers Male/Female as follows:

14 & Under; 15-19; 20-24; 25-29; 30-34; 35-39; 40-44; 45-49;

50-54; 55-59; 60-64; 65-69; 70-74; 75-79; 80+

Each Participant must fill out an Entry Form. To register additional participants, please duplicate this form or visit www.miles4matt.org for additional forms.

MAIL IN REGISTRATION

Name: Birthdate:_ /_ /_ Company: Address: City/State/Zip: Phone: Race Day Age: Email: PLEASE CHECK:

5K Run/Walk Male Female Special Needs

I am unable to participate, however I would like to make a donation of $_ .

ENTRY FEE: (If registered by 5/15/14)

$25 – 5K Run/Walk

$15 – 5K Run/Walk (student – grades 12 & under)

LATE & RACE DAY ENTRY FEE: (If registered 5/16/14 – 5/31/14)

$30 – 5K Run/Walk

$20 – 5K Run/Walk (student – grades 12 & under)

T-SHIRTS PROVIDED TO PARTICIPANTS WHILE SUPPLIES LAST!

Please circle t-shirt size: S M L XL

TOTAL ENCLOSED: $

image

MAKE CHECKS PAYABLE TO: MILES FOR MATT FOUNDATION

I hereby waive and release any and all rights and claims I may have against the Miles for Matt Foundation, Nassau County Department of Parks and Recreation, and the race Sponsors for damages which I may have arising out of this event. I am physi- cally fit and have trained for this race. The applicant warrants that “my physical condition has been verified by a licensed medical doctor.” “Further, I hereby grant full permission to any and all of the foregoing to use any pictures, or any record of this event for any purpose whatsoever.”

If signed by a parent, the parent agrees to release and hold the above named organizations and persons harmless of any claims which may be asserted by or on behalf of the entrant. Cedar Creek Park and Miles for Matt Foundation reserves the right to cancel this event in the case of inclement weather for safety concerns. No refunds.

image

SIGNATURE /DATE

Questions?

Email: miles4matt@aol.com Call: 631-662-5415

Mail Application to:

Miles for Matt Foundation

Att: Lynn Scarpati

P.O. Box 20117

Huntington Station, NY 11746

Register online at: www.justregister.net

Timing and Results: JustFinish.net

For more information about Miles for Matt Foundation, please visit : www.miles4matt.org

Miles for Matt Foundation is a 501(c)(3) Tax ID # 27-1733654


182 Responses to “The 1st Annual Miles for Matt Foundation Celebrate Life 5K Run/Walk”

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    unlike@underlie.amplified” rel=”nofollow”>.…

    hello!!…

  182. Jason Says:

    veronica@helping.compressive” rel=”nofollow”>.…

    ñïñ….


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