Burley High School Class of 2001 Benefit 5K FUN RUN

"A Run Down Memory Lane"

Date Saturday, August 20, 2011 Time 9:00 AM Course The Benefit FUN RUN will begin and end at the Burley High School track. We will be running/ jogging/ walking from the new Burley High School track, past the old High School, around the Junior High, and back. The course is approximately 5K. A water station and first aid kit will be available. Benefit Proceeds will benefit our Burley High School teacher Mr. Richard Call, to help with the health issues he has been battling. Additional donations are welcome! Registration $15/participant $10/Members of BHS Class of 2001 Make checks payable to: Burley High School Class of 2001 OR via Pay-Pal at: www.bhsclassof2001.blogspot.com Mail entry form and money to: BHS Fun-Run 2001 362 W. 200 N. Rupert, ID Registration fee includes FUN RUN t-shirt and refreshments. FUN RUN Day Check-In 8:30 AM 8:50 AM Submit Entry Form, pay registration fee, and pick up t-shirt at check-in **T-shirts are only guaranteed for registrations submitted by AUGUST 1st** Post-Race Water and refreshments will be provided at the end of the race. ***For questions, contact: ajwilkins@gmail.com*** __________________________________________________________________________________________________

Benefit FUN RUN Entry Form

Name _________________________________________ Address _______________________________________ City _________________________ State ____ Zip _____
Phone _________________ Sex __ Age ___
Note: For the safety of all participants, bikes, skateboards, scooters and skates of any kind are prohibited in this event. Waiver of Liability: In consideration of my entry being accepted, I waive any and all claims for myself, my administrators, and my heirs against all officials, sponsors, and organizations connected with the Burley High School Class of 2001 Benefit FUN RUN for injury or illness that may directly or indirectly result from my participation in this event. I attest that I have full knowledge of the risks involved in this event, and am physically fit able to participate in this event.

Signature _____________________________ Date ________

Parent or guardian if under 18 years of age

Email________________________
Registration Fee $ ____________ T-shirt size: S M L XL XXL (circle one)