5K ANEW RUN/WALK

Saturday, June 18, 2011

Empowering individuals and

the community to end violence
and begin anew

Date and Time: Saturday, June 18th at 9:30 am

Registration: Registration from 7:30 - 9:00 am

The Salvation Army Gymnasium
83 S. Main Street, Jamestown, NY

Entry Fee: $20 .00

Pre-registration ends on June 13, 2011
Pre-registered participants will be guaranteed a T-shirt

Prizes/Awards: Participant to raise the highest amount of pledges will receive a new IPod
Award given to overall top male and female runner
5K Run awards to first three male and female finishers in each age group
5K Walk awards to first finisher in each age group

Age Categories: 14 & under, 15-19, 20-29, 30-39, 40-49, 50-59, 60 & over

Registration on reverse side or register online at Active.com

For information contact Stacey Tanner at 661-3894 or email stacey.tanner@use.salvationarmy.org

Race Management by Chautauqua Striders

The Runner of the Year Series is sponsored by WCA Center

for Orthopedics, Sports Medicine & Rehabilitation
 5K ANEW RUN/WALK REGISTRATION

Name_________________________________________
Address_________________ ____________ _______
City/State/Zip_____________________________ ____
Phone___________________________
Birth Date________________________ Age ____________ Gender _____________
Email Address _____________ _____________________________ __

T-shirt Size: ___XS ___S ___M ___L ___XL ___XXL

I will be participating as a:
___Runner ___Walker ___Donation Only

Race Route: Participants will start in front of the JAMA Riverwalk building and travel west on Harrison, make a right
to travel north on Main Street, then turn left onto 3rd, left onto Hallock, left onto Front, right onto Sprague, left onto
Baker until reaching Harrison Street to turn right and end back at the JAMA building.

Please Park in the JAMA parking lot and NO Dogs, Roller Blades, or Bikes.

Mail this form along with payment to :

The Salvation Army, 83 South Main Street, Jamestown, NY 14701

Proceeds will benefit The Salvation Army Anew Center which provides comprehensive
services to victims of domestic violence, rape, and child abuse.
In consideration of The Salvation Army accepting this entry, I, undersigned, intending to be legally bound, hereby for myself, my heirs,
executors and administrators, waive and release any and all rights and claims for damages which may hereafter accrue to me against The
Salvation Army, the City of Jamestown, Chautauqua Striders, Inc., and WCA Hospital and any and all other sponsors, their representatives,
successors and assigned for any and all injuries, including death, suffered by me in said event or arising out of my participation or traveling to
and/or from said event. I have read the above statements. I fully understand them and my signature confirms their full acceptance. I attest and
verify that I have full knowledge of the risks involved in this event, and I am physically fit and sufficiently trained to participate in this event. I
further grant permission to use any photographs, motion pictures, or any other record of this event for any legitimate purpose.

Signature:__________________________________________________________________________________________________

Signature:_________________________________________________________________________________________________
(Parent/Guardian if participant is under the age of 18)

PLEDGE FORM

SPONSOR’S NAME PLEDGE AMOUNT SPONSOR’S NAME PLEDGE AMOUNT

1._________________________________________ 6._________________________________________

2.____________________________ ____________ 7.____________________________ ____________

3._________________________________________ 8._________________________________________

4._________________________________________ 9._________________________________________

5._________________________________________ 10._________________________________________