HHH 5K RUN/WALK WELLNESS FAIR AND FAMILY FUN RUN Registration Information: www.thelastmileracing.com Name _______________________________ Address: ________________________________________ City: _________________________ State: _____ Zip Code: _________ Phone: _________________ E-Mail: ____________________________ Age: _______ D.O.B.: ____/____/____ Male □ Female □ Check one: 5K Run/Walk □ Family Fun Run □ Please fill out entry blank, read the following statement and sign below. In consideration of your accepting this entry, I the undersigned, intending to be legally bound do hereby, for myself, my heirs, executors and administrators, waive and release and hold harmless the HHH School District and PTA, The Last Mile, all sponsors, Suffolk County Police, Volunteer Fire Dept. of Dix Hills, the Town of Huntington and all their representatives, successors and assigns, for any and all liabilities, claims, demands and causes of action whether or not aris- ing in whole or in part out of the negligence of the above organizations or individuals. I attest and verify that I am physically fit and have sufficiently trained for the completion of this event and a licensed Medical Doctor has verified my physical condition. If signed by a parent, the parent agrees to release and hold the above-named organizations and personnel harmless of any claims which may be asserted on behalf of the entrant. Further, I hereby grant permission to any and all of the foregoing to use any pho- tographs, videotapes, motion pictures, recordings and any other record of this event whatsoever. Signature: ________________________________________ Date: ___________________ (Parent’s signature, if under 18 years old) Make check payable to: Mail to: Attention 5K Run HHH CSD HHH PTA Council, 525 Half Hollow Road, Dix Hills, NY 11746 Location: High School East 50 Vanderbilt Parkway Dix Hills, NY 11746 RACE DAY Check-in Time: 7:30 - 9 a.m. at HS East, west gym START TIMES : Family Fun Run 9:00 a.m. 5K Run/Walk 9:30 a.m. Wellness Fair 9:00 a.m.– 1:00 p.m. T-Shirts/goodie bags to the first 300-5K registrants Indicate Shirt Size: Adult S___M___L___XL___ EARLY ENTRY FEE (postmarked by Oct. 28, 2011) 5K Run/Walk $20.00 Adult; $5.00 Child (up to grade 12 ) T-shirts & Goodie bags for all early entry runners Fun run Free Medals for all fun run participants ON RACE DAY 5K Run/Walk $25.00 Adult, $10.00 Child (up to grade 12) Fun activities to follow run For more information please contact: Patrick Murphy @ 631-592-3067 or Christina Noriega @ 631-667-7759 Online registration available @ www.thelastmileracing.com Sponsored by: PROSPECT SPORTS Free Screenings & Demos! Food! Free Raffles Run / Walk through the beautiful rolling hills of Dix Hills! WALKER FRIENDLY! 5K Awards: Top Overall Male/Female receive medal and gift basket Age Group - 3 Deep in 5-year age group Medals for 1st, 2nd & 3rd in each group LITF Certified Course Half Hollow Hills School District and PTA Council Present The 4th Annual Wellness Fair alf ollow ills