Jersey Shore University Medical Center

Jersey Shore University Medical Center

8th Annual 5k Run/Walk and Community Day

Save the Date!

Sunday, September 17, 2017

Jersey Shore University Medical Center 1945 Route 33 Neptune, NJ

For more information or to register online visit

JerseyShoreUniversityMedicalCenter/5kRace

Race Day Registration and Check-in: 8:30 a.m. 5k Start Time: 10 a.m. Course: Flat and Fast through Neptune. Electronic timing.

First 200 registrants before September 10, 2017 will receive a t-shirt. Registration fee is $10 before September 10, 2017, and $20 on race day.

Join us for an awards party, food, games, health screenings, children's health fair, and more.

Awards: J Prizes awarded to Top 3 Overall ? Male & Female J Free Kids' Activities J P rizes awarded to Top 3 Male & FemaleFinishers J Strollers welcome

(in 5 year age groups)

First Name:____________________________________________Last Name:____________________________________________

Address:_____________________________________________________________________________________________________

City:___________________________________________________State:________________ Zip:______________________________

Phone:________________________________________________E-mail:___________________

Age on Race Day:_____________________________________________________________________________________________

Male

Female

Hackensack Meridian Health Team Member Shirt Size: S M L XL (Please circle one)

Waiver/Release: In consideration of this entry being accepted, I hereby for myself, heirs, executors, & administrators waive and release any claims I may have against Jersey Shore University Medical Center, the event organizers, volunteers, sponsors and (or) any representatives involved in the 5k Run/Walk for any and all injuries suffered by me. I certify that I am physically able to compete in this event.

Signature:__________________________________________________________________ Date:____________________________

Parent/Guardian Signature (if under 18):________________________________________ Date:____________________________

For information, visit 5kRace or e-mail JSUMCrace@.

Make checks payable to: Jersey Shore University Medical Center Mail: Jersey Shore University Medical Center 5k P. O. Box Neptune, NJ 07753

REGISTRATION FORM

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