END POLIO NOW

FEED MY STARVING CHILDREN

2017 8K RUN / 3K Walk

Saturday, September 30, 2017 Start @ 8 AM

Start and finish line will be Grove 31, Busse Woods Trail

(Higgins Rd. Busses Forest West)

Registration:

1. By Mail : Send completed entry form and check (payable to : RCCKN)-The Rotary Club of Chicagoland Korean-Northbrook

*** Must be post marked by Sep 26, 2017 ***

Mail to: RCCKN

6116 N Lincoln Ave

Chicago, IL 60659

2. On site : Sep 30, 2017, Saturday 07:00AM-07:30AM

3. Fee: (nonrefundable & non-transferable)

* $25 per person

4. Contact: Please visit website

www.rotary8krun.org

ENTRY FORM Entry NO: ______

One entry form per participant-Please print

Last Name ______First Name ______

Address ______

City ______State ______Zip Code ______

Main Tel #: ______

E-mail ______

Date of Birth _____/_____/_____ Gender M ______F ______

Group / Under20 / 20-39 / 40-59 / Over 60
Men / M1 / M2 / M3 / M4
Women / F1 / F2 / F3 / F4

Adult Shirt Size (Circle one) *** RUN or Walk? (Circle one)***

S M L XL 8K RUN 3K WALK

Waiver

In consideration for my right to participate in the 2012 END POLIO NOW 8K RUN/WALK, I, my heirs, executors, and administrators, hereby release Korean Rotary 2012 END POLIO NOW 8K RUN/WALK Foundation committee, The Rotary Club of Chicagoland Korean-Northbrook and Park District and any of their officers, agents, servants, employees, and all other sponsors of the run (collectively the “indemnities”) from, and I hereby waive, all claims for injury or damages to person or property sustained by me or by any third party arising out of caused by or resulting from my participation and I hereby agree to indemnify and hold the indemnities harmless from any such claims and all expenses arising there from. I further warrant that I have trained for a race of this distance and under these weather conditions and that I am fit to enter. I also participate with knowledge and understanding of any recommendations made by my physician or medical service.

* Runner/walker Signature

______Date ____/____/____

I understand as parent or legal guardian of the participant, I hereby acknowledge and agree to be bound by the foregoing waiver, release and indemnification.

* If under 18, Signature of Parent or Guardian.

______Date ____/____/____

* Unsigned entries will NOT be accepted.