murph

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Run for Murph Entry Form (Please Print) CHECK RACE(S): _________1 Mile _________5K TOTAL FEE ENCLOSED: $_________ FIRST NAME:_______________________________ LAST NAME:_______________________________ ADDRESS:__________________________________ CITY:_______________________________ STATE:_______________ ZIP:_______________ AGE: __________ SEX (please circle): Male Female EMAIL:_________________________________________ TELEPHONE: ________________________________ Date of Birth D.O.B.:_______________ Age:_______________ Waiver: In consideration of Saint Ignatius High School and Hermes Sports & Events granting me the permission to engage in the recreational activity set forth above, the undersigned does hereby waive, release, save and hold harmless and indemnify Saint Ignatius High School, their organizers, officers, employees, agents and sponsors, and Hermes Sports & Events for any and all claims for damage from personal injury to me or loss of property which may becaused by any act or failure to act on the part of Saint Ignatius High School, their organizers, officers, employees,agents and sponsors and Hermes Sports & Events. The undersigned further assumes the risk of all dangerous conditions in and about Saint Ignatius High School and property both real and personal and waive any and all specific notice of the existence of such dangerous conditions, if any. I hereby grant full permission to any or all of the foregoing to use any photographs, video tapes, motion pictures, recordings, or any other record of this event for anylegitimate purpose.We reserve the right to reject entries. Signature __________________________________ Date___________ Signature__________________________________ Date___________ (Parent/Guardian if Under 18 yrs) Entry Fee: Pre-registration: Each runner requires an individual entry for each participant Individual - $20 Family Rate - $60 - Family of 4 ($15 per each additional) Team Discount - $15/runner (10 or more runners, entries & payment in one envelope) MAIL IN ONLY Registration: All mailed entries must be received by Friday, September 10th, 2010 Make checks payable to Hermes Sports and Events and mail entries to: Hermes Sports and Events 1624 Saint Clair Avenue Cleveland, Ohio 44114 Day of Race Registration: 5K & 1 Mile - $25 Family -$70 Family of 4 ($18 each additional) On-Line Registration: Register @ www.hermescleveland.com Deadline is September 15, 2010 at 9:00am Awards: Top three overall (male & female) and top 3 in each age group (male & female) Age Divisions: 5K: 10 & under, 11-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55 & over More Info: Contact Coach Previts at 216-634-8802 or [email protected] Call Hermes Sports & Events 216-623-9933 Presented by Glacial Energy & Patrick McIntrye

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Page 1: Murph

Run for Murph Entry Form (Please Print) CHECK RACE(S): _________1 Mile _________5K TOTAL FEE ENCLOSED: $_________

FIRST NAME:_______________________________ LAST NAME:_______________________________

ADDRESS:__________________________________ CITY:_______________________________ STATE:_______________ ZIP:_______________

AGE: __________ SEX (please circle): Male Female EMAIL:_________________________________________

TELEPHONE: ________________________________ Date of Birth D.O.B.:_______________ Age:_______________

Waiver: In consideration of Saint Ignatius High School and Hermes Sports & Events granting me the permission to engage in the recreational activity set forth above, the undersigned does hereby waive, release, save and hold harmless and indemnify Saint Ignatius High School, their organizers, officers, employees, agents and sponsors, and Hermes Sports & Events for any and all claims for damage from personal injury to me or loss of property which may becaused by any act or failure to act on the part of Saint Ignatius High School, their organizers, officers, employees,agents and sponsors and Hermes Sports & Events. The undersigned further assumes the risk of all dangerous conditions in and about Saint Ignatius High School and property both real and personal and waive any and all specific notice of the existence of such dangerous conditions, if any. I hereby grant full permission to any or all of the foregoing to use any photographs, video tapes, motion pictures, recordings, or any other record of this event for anylegitimate purpose.We reserve the right to reject entries.

Signature __________________________________ Date___________ Signature__________________________________ Date___________ (Parent/Guardian if Under 18 yrs)

Entry Fee: Pre-registration: Each runner requires an individual entry for each participant Individual - $20 Family Rate - $60 - Family of 4 ($15 per each additional) Team Discount - $15/runner (10 or more runners, entries & payment in one envelope) MAIL IN ONLY

Registration: All mailed entries must be received by Friday, September 10th, 2010 Make checks payable to Hermes Sports and Events and mail entries to: Hermes Sports and Events 1624 Saint Clair Avenue Cleveland, Ohio 44114

Day of Race Registration: 5K & 1 Mile - $25 • Family -$70 • Family of 4 ($18 each additional)

On-Line Registration: Register @ www.hermescleveland.com • Deadline is September 15, 2010 at 9:00am

Awards: Top three overall (male & female) and top 3 in each age group (male & female)

Age Divisions: 5K: 10 & under, 11-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55 & over

More Info: Contact Coach Previts at 216-634-8802 or [email protected] • Call Hermes Sports & Events 216-623-9933

Presented by Glacial Energy & Patrick McIntrye