Hello Teddy SHF Roosevelt Run 5K
Thursday, August 28, 2014, at 7:00 PM
Trailhead of GW Parkway Trail at Key Bridge

Start across from Gateway Park in Rosslyn and run along the Potomac River

Full information: 703-927-4833 • racedirector@att.net

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$20 by August 3, $26 by August 23, $32 by August 27, $40 on August 28
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  • Roosevelt Run 5K • REGISTRATION FORM
    Make checks payable to SHF, 611 South Ivy Street, Arlington VA 22204

    Name ___________________________________________________________  Gender (M F) [__] Age as of 08/28/2014 [__ __]

    Address _________________________________________________________  Birthdate __ __ - __ __ - __ __ __ __ (mm-dd-yyyy)

    City ST ZIP ______________________________________________________  Phone __ __ __ - __ __ __ - __ __ __ __

    E-mail ___________________________________________________________     T-shirt size [__] S M L XL  
    Enclosed is my entry fee:

    Mail-in prices:  $20 by August 3: [_]         $26 by August 23: [_]         $32 by August 27: [_]         $40 on race day: [_]         Enter on-line

    Enclosed is an additional donation of $_____ to [_] SHF

    By entering this event, I agree, warrant and covenant as follows:I know that running is a potentially hazardous activity. I should not enter or run in club activities 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 in this race including, but not limited to, falls, contact with other participants, the effects of weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your acceptance of my application I, for myself and anyone entitled to act on my behalf, waive and release Safety And Health Foundation, Arlington County Virginia, National Park Service, Georgetown Running Company, Road Runners Club of America, USATF, and all sponsors, their directors, officers, employees, agents, representatives and successors from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I acknowledge that the application fee shall be non-refundable. I agree that the sponsors of this event may use my name and likeness for publicity purposes.
    Signature _________________________________________________________ (parent or guardian if under 18)  Date _______________
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