REGISTRATION FORM THANKSGIVING DAY 10K 8:15 a.m. | 5K 9 a.m.

REGISTRATION FORM
WESTERN HEALTH ADVANTAGE’S 21st annual
5K/10K Run & 5K Fun Run/Walk
presented by KCRA 3 / KQCA 58
benefiting Sacramento Food Bank & Family Services
Donation
Registration
___ Timed Adult
$40
___ Timed Child*
$25
___ Untimed Adult $35
___ Untimed Child* $30
___Virtual Runner $35
*Child is age 15 and under
Gender: M F
Circle one
Please accept my
additional donation** of
$___________________
THANKSGIVING DAY
November 27, 2014
10K 8:15 a.m. | 5K 9 a.m.
Helpful tips:
 Postmark by November 12, 2014
 Only 7,000 timed registrations available
 Only early bird and regular registrants (by
November 21) are guaranteed a shirt
 Make check payable to SFBFS
 Only one person per entry form
 Complete and sign waiver on each entry form
 Use credit card billing address below
OFFICE USE ONLY
Bib Number:
Payment Type:
Mail this form and payment to:
Run to Feed the Hungry
c/o SFBFS
3333 Third Avenue
Sacramento, CA 95817
(Tax ID #94-3315566)
**e-mail required for
donation receipt
Age: _____
Shirt Size ADULT: S M L XL XXL XXXL YOUTH S M L
Circle one
First Name: ________________________________________ Last Name: _____________________________________________________________________
Address: ___________________________________________________________________________________________________________________________
Contact e-mail***: __________________________________________________________________________ Phone***: __________________________________
Waiver and Signature: In consideration of your accepting my entry, I, intending to be legally bound, do hereby for myself and my heirs, executors, administrators waive and release any and all rights and claims for damages I may accrue against the
persons and organizations affiliated with the race including but not limited to Sacramento Food bank & Family Services, City of Sacramento, Sacramento State, Scottish Rite Temple, Capital Road Race Management, all sponsors, volunteers, staff,
subcontractors, agents, attorneys ad representatives for any and all injuries that may suffer while participating in the event or en route to and from the event. I consent to the use of my image in photos, videos and audio recording and film, of my
participation in the event. I attest that I am physically fit and sufficiently trained for this competition, my physical condition verified by a licensed M.D. during the last 6 months. As part of the waiver, I acknowledge that I have read and understand all of
the above.
Signature****: ______________________________________________________________________________ Date: ____________________________________
Payment: __ VISA ___ MC __ AMEX Card Number: ___________________________________________________________ CVV: _______ Exp: ___________
Name on Card: ______________________________________________________________________________________________________________________
Signature: __________________________________________________________________________________________________________________________
*** Required
****All entrants must sign waiver, unsigned entries cannot be accepted (parent/guardian if under 18). All entrants must have separate entry form, copies attached.