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DATE: Saturday, October 20, 2018 TIME: Registration 9 – 10:15 am Start : 10:30 am PLACE: Wright Physical Therapy Burley 1945 Hiland Ave, Burley, ID 83318 This Fun Run/Walk 5K Fundraiser to raise awareness and money needed for breast cancer. The Race/walk will start at Wright Physical Therapy 1945 Hiland Ave in Burley. We also have a 1 mile course for kids, families or people that want to walk. The cost includes a gift bag with shirt for adults and goodiesfor kids. Find the Route Map on the back page! Pre-order your hoodies Text Justin Jensen at [PHONE REDACTED] REGISTRATION FORM 5K COLOR RUN/WALK Complete this form for each event participant (list family names on the back) and return/mail to Wright Physical Therapy Burley Location (1945 Hiland Ave, Burley, Idaho 83318) First Name: Last Name: Gender: Male / Female Age: Email: Phone: Address: Single: $30 Familly of 4: $60 Team of 4: $100 Signup before October 8th and get a discount Single: $25 Family of 4: $50 Team of 4: $80 Are you running or walking? Running / Walking 5K T-Shirt Size (For adult participants only)? S M L XL XXL XXXL WAIVER I know that running is a potentially hazardous activity. I should not enter or run in this event unless I am medically able and physically able. I agree to abide by any de- cision of a race official relative to my ability to safely complete the run/walk. I as- sume all risks associated with running/walking in this event including but not limited to, falls, contact with other participants, the effects of weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. All fees are nonrefundable. In the event of extreme weather conditions or some other unforeseen act of God that may prohibit the race, all fees are nonrefundable. Having read this waiver and knowing these facts, and in consideration of your acceptance of my application, I, for myself and anyone entitled to act on my behalf, waive and release the event, and all sponsors, their participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. Registration will not be accepted without acknowledgment of waiver sign Signature: Date: ---PAGE BREAK--- MAIL OR DROP OFF TO: WRIGHT PHYSICAL THERAPY, 1945 HILAND AVENUE, BURLEY, ID 83318. OR BURLEY FIRE DEPARTMENT, 1235 MILLER AVE. BURLEY, ID 83318 FAMILY 0R TEAM OF 4: FILL OUT FOR EACH PARTICIPANT: Name: Gender: M / F walk/run shirt Name: Gender: M / F walk/run Shirt Name: Gender: M / F walk/run Shirt Name: Gender: M / F Walk/run Shirt MAKE CHECKS PAYABLE TO: BURLEY FIRE