You may bring your application by the Foundation office or just call Pam @ 743-7367 to register you or your team and bring your application with you to the event. Thank you for helping with this cause. Monroe Health Foundation 5K for Diabetes August 15, 2009 8 AM Monroeville, AL Benefits: Monroe Health Foundation Diabetes Education Organized by: Monroe Health Foundation Produced by: Little Red Hen Productions Location: Water Tower Conference Center, 181 East Claiborne St., Monroeville, AL Distance: Certified 5K course (AL08035JD) through historic Monroeville, AL. Registration: Register by mail (entries should be postmarked by August 8, 2009), in person at the Monroe Health Foundation office in Monroeville, and McCoy Outdoor in Mobile, AL until 6 PM on Thursday, August 13, 2009, or online (www.Active.com) until midnight August 13, 2009. Race day registration in front of the old Courthouse in Monroeville. Entry fees: Pre-register - $15.00 Day of Race - $20.00 - We are asking that each participant raise $100.00 for the cause, your registered fee will be including. Awards: Awards presented to the top male and female Overall, Masters, Grandmasters, Senior Grandmasters, and Race Walker. Top three male and female in age groups: 9 and under, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, and 75-99. Shirts: Race shirts guaranteed for all participants pre-registered by August 8, 2009. Race shirts on race day while supply lasts. Post-Race Party: The post-race festivities include activities at the Courthouse Lawn. All finishers will receive food and beverages while enjoying music. Awards Ceremony will be held on the front steps of the Courthouse. Monroeville Hotel Accommodations: Monroe Inn (251)575-3312 If the weather is unseasonably warm or cold, use the customary racing precautions with which you should be familiar and take advantage of the water along the course. Stop running/walking and seek help if you stop sweating and feel nauseous or dizzy. If you see a fellow runner/walker who appears to be in trouble, please stop and help if you can. --------------------------------------------------------------------------------------------------------------------------------------- Last Name: ___________________________________ First Name: ________________________ Address: _________________________________ City, ST & ZIP: _________________________ Age: _____ Sex: M F Date of Birth: ______________ Style: Runner Racewalker Email: ____________________________________________ Phone Number: _______________ T-Shirt Size: S M L XL XXL Additional donation to Monroe Health Foundation: $ ___________ I know that running a road race is a potentially hazardous activity that could cause injury or death. I should not enter and run unless I am medically able and properly trained, and by my signature I certify that I am medically able to perform this event, am in good health and am properly trained. I agree to abide by any decision of a race official relative to any aspect of my participation in this event, including the right of any official to deny or suspend my participation for any reason whatsoever. I assume all risks associated with running or walking in this event, including but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. I understand that bicycles, skateboards, baby joggers, roller skates or blades, animals, and radio headsets are not allowed in the race and I will abide by these guidelines. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release Monroe Health Foundation, LLC, Little Red Hen Productions, all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event on August 15, 2009, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. Signature of Participant ___________________________________________________________ Date ________________________ (Parent/Guardian must sign for participants under 19) Make checks payable to: Monroe Health Foundation. LLC Mail applications and fees to: Little Red Hen Productions; MHF 5K; PO Box 6976; Mobile, Alabama 36660