The 5th Annual Michael Michelini 5K
to
 Benefit The Leukemia and Lymphoma Society

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REGISTRATION APPLICATION
           5th ANNUAL MICHAEL MICHELINI 5K RACE

All Proceeds to Benefit the Leukemia and Lymphoma Society

                                                                         WIN * ROCK * CURE

 

Date:                            Sunday, October 20, 2013 – 1:00 PM SHARP

Distance                       5K (3.1 miles)

Location/Course:          Start: Islip Town Hall, corner of South Bay Avenue and Montauk Hwy to Islip Town Beach, and back to Islip Town Hall area.  Straight and flat, just like we like em’.

Entry Fee:                    $30 pre-registration or $40 day-of-race registration

Deadline:                      Pre-registration entries must be postmarked on or before 10/10/13                                                  

Day Of Race Check In  11:00 AM – 12:30 PM in front of Islip Town Hall           

Timing                          Start2Finish                                                        

Awards:                        Presented to the first overall male and female finishers; first male and female Islip Village residents; and the top 3 male and female runners in the following age categories:  14 and under, 15-19, 20-24, 25-29, 30-34, 35–39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, and 75+

Directions:                    Southern State Pkwy to Route 111 South to Rte. 27A (Montauk Highway).  Make a right at the traffic light, and Registration/Sign-in is 100 yards down on the right.   

Info & Questions:          kedwards@cancersucks5K.com

Online Registration        GO TO ACTIVE.COM  AND SEARCH: MICHELINI
  Only Pre-registered participants are guaranteed race t-shirts!!!

LIVE MUSIC BEFORE AND AFTER THE RACE BY BLIND SQUIRRELS

   

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   5th Annual Michael Michelini 5K Race
Race Application

NAME _______________________________________________________   AGE ___ ___ SEX ___

ADDRESS _______________________________________________________________________

TOWN ___________________________________________ STATE _________ ZIP ____________

PHONE _____________________________  EMAIL _______________________________________________

T- shirt size (Circle one):             Medium              Large                Ex-Large

Make checks payable to:             The Leukemia and Lymphoma Society    

Mail checks to                             Kevin Edwards
                                                   
131 Brightside Avenue

                                                    Central Islip, NY11722

WAIVER: In consideration of the acceptance of my entry, I hereby, for myself, my heirs, executors and administrators, waive, release and forever discharge any and all rights and claims for damages which I may have or which may hereafter accrue to me while traveling to and from or participation in the Michael Michelini “ Cancer Sucks” 5K, against the Town of Islip, the County of Suffolk, the State of New York, Start2Finish and their respective offices, agents, representatives or successors, along with any sponsors, supporters and volunteers of said event, as a result of my participation in said run.  I hereby attest and verify that I have full knowledge of the risk involved in participating in this event and that I am physically fit and sufficiently trained to participate.  I have read the above statement, and I understand it and my signature confirms its full acceptance.

 

_________________________                      _______________________________________

                     Date                                              Signature (or Parent/Guardian Signature if under 18)   

  

   

 

   

 

   

 

 

 

 

 

 

 

 

For ONLINE Registration, go to Active.com and register with a credit card. Thanks.
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