Turkey Hill 10000 10K Entry Form for 2005

ENTRY FORM			Turkey Hill 10000 10K Road Race - 2005

Please enter me in . . . (please check one)

	Turkey Hill (10K) $16 by March 28th or $20 thereafter
	Health America / Health Assurance Jelly Bean 1/3 mile Kids Run - for children 12 & under $7 by March 28th or $10 thereafter

Name:				Age		Sex	Birth Date:

Street Address						City

State		Zip		Telephone (with area code)

Previous Best Time minutes seconds						year

I know that running the 10K run is a potential hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running the event including, but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity and cold or slippery conditions of the race course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my application, I for myself and anyone entitled to act on my behalf, waive and release the race director, race officials and volunteers, any and all sponsors including, but not limited to all their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. Waive and release to the I.O. Silver Games the right to use photographs taken at this event.


Signature


Co-Signature (Parent/Guardian must cosign if applicant is under 18 years of age)

Shirt Size (subject to availability after April 1st) please check one:					Total amount enclosed: $

	small		medium		Please make check payable to I.O. Silver Games
					Please make check payable to I.O. Silver Games
	large		extra large

Mail entry form and payment to: I.O. Silver Games/Turkey Hill 10K c/o Cindy Liddick Division of Cardiology PO Box 850, MC H047 Hershey, PA