Lions Club of the Brookfields and The North Brookfield Youth Center

Present:

The Apple Run/Walk

for Diabetes

Saturday, November 2, 2013

at 9:30 am-Walkers    10am-Runners

-The Apple Run/Walk is a 5 mile Road Race/Walk through scenic North Brookfield.  The Race begins and ends at the Brookfield Apple Orchard, 12 Lincoln Road.  An adult must accompany children running this course. 

Entry Fee: $20.00 by mail or in person.  T-shirts will be given to pre-entries received by Oct. 19th.  Entries can also be sent in after this date or brought on race day.  Registration on the 2nd  begins at 8:30 am and ends at 9:30 am

Entry fee for children:   $10.00  for children age 17 and under (additional $5 for a T-shirt, - if desired - received by Oct. 19th .)

-Make checks payable to:  Lions Club of the Brookfields

-Mail to:  North Brookfield Youth Center

               P.O. Box  86

               North Brookfield, MA  01535

               Attn:  Marty Toomey/Race

-Prizes of $100, and $50 will be awarded to the overall 1st and 2nd place male and female finishers. Other prizes will go to the top finishers in each age category.

-Official timing provided by 5K Sports Race Management

-All proceeds will benefit the Clara Barton Camp, a camp to educate young girls with diabetes and the Diabetes Research Team at UMASS.

-For more information, contact Marty Toomey, 774-200-0938/ mtoomey_nbyc@charter.net

Name________________________________   Phone_____________________________

Address______________________________  Email_____________________________

Age_____ Sex: M__ F___            T-shirt size:  S__M__L__ XL___XXL___

-Waiver of Responsibility must be signed for registration to be considered valid.

I agree to assume all responsibility for all risk of damage or injury to me as a participant in this event.  In consideration of being accepted as an entrant in the Apple Run/Walk for Diabetes, I hereby, for myself, my heirs, executors and administrators, release and discharge all organizations and individuals associated with the race from all claims, damages, rights of action, present or future, whether the same be known, anticipated, or unanticipated, resulting from or arising out of, or in incident to, my participation in this event.  I hereby certify that I will not participate in the run/walk unless I am physically fit and sufficiently trained for completion of the event.  I also give permission for the use of my name and/or picture in any broadcast, photograph or other account of this event.

Signature (required)______________________________________________________

Parent Signature (if under age 18)_______________________________________________

-A pledge form is on the back of this registration form. 


 
 
     
 
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