Run for Education - PHM Education Foundation

silver mile
HEALTH AND FITNESS FAIR
Run for Education
5K Run/Walk, 1-Mile Timed Run, 1-Mile Fun Walk
May 9, 2015
ENTRY FORM / FILL OUT ONE FORM PER PARTICIPANT
(Extra forms can be downloaded from phmef.org)
NAME:_______________________________________________________________________________________________________
Last
First
Middle
ADDRESS:__________________________________________________________________________________________________
CITY/STATE/ZIP:____________________________________________________________________________________________
PHONE:_______________________Birthdate:________________SEX:_________E-MAIL:________________________________
(month/day/year)
5K Run/Walk (9am)
 Adult: $30
 Student K-12: $20
 Adult/Student Combo: $40
1 Mile Fun Walk (9:05am)
 Adult: $15
 Student K-12: $12
 Family of 4 or more (from same address): $45
NEW! 1-Mile Timed Run (10:45am)
 $15
 Timed Mile with 5K
registration: $8
REGISTRATION FEES – Prices valid for mail-in registrations postmarked by April 28 and online registration by April 30.
LATE REGISTRATION FEES – Effective May 1 with no race shirt guarantee. Add $5 per event entry for late registration.
T-SHIRT SIZE- Each participant will receive a T-shirt. Check one size only. Additional participants must submit a separate form with
their own T-shirt sized marked.
Youth
Adult
 S
 S
 M
 M
 L
 L
 XL
 XXL ($2 extra)
 XXXL ($3 extra)
If you wish to purchase additional shirt(s), the cost is $11 each: Indicate Size and Quantity __________________________

$2 Discount for MRA Members. Please bring membership ID to packet pickup.
Entry Fee Total:
_____________
(Add $5 per event entry if registering after April 30.)
Extra T-shirt Total (optional): _____________
(Minus $2 MRA discount:)
_____________
TOTAL ENCLOSED:
_____________
RELEASE & WAIVER
Please make check payable to the P-H-M Education
Foundation and mail to:
P-H-M Education Foundation
Run for Education
55900 Bittersweet Road
Mishawaka, IN 46545
I know that running and walking a race is a potentially hazardous activity. I should not enter unless I am medically able and properly trained. I, on my
behalf or on behalf of my child, agree to assume all risks associated with my, or my child’s, voluntary participation in the Run for Education,
including but not limited to, falls, contact with other participants, or the effects of the weather, all such risks being known and appreciated by me.
Knowing these facts and in consideration of your accepting my entry, I, for myself, my heirs, executors, and administrators WAIVE, RELEASE, AND
DISCHARGE all rights and claims for damages I may have against the Penn-Harris-Madison Education Foundation, Inc., the sponsors of this event,
the Penn-Harris-Madison School Corporation, and their respective agents, employees, representatives, and members for any and all injuries suffered
by me or my child at any time during my participation at the Run for Education and Silver Mile event. All images recorded at the Silver Mile Event
can be used for promotions by the P-H-M Education Foundation, unless you notify us otherwise.
Participant Signature (or Guardian if participant is under 18) _____________________________________Date_____________
 Please check here if you are a student athlete who is ineligible for awards
PLEASE NOTE: Refunds cannot be made once registration is accepted. No refunds are
made due to cancellation of the event for whatever reasons as determined by the race management
company and the P-H-M Education Foundation, Inc.