Registration Form

Jim Hegedus Memorial 5K Run

Date: June 19 , 2010 (Rain or Shine)
Veterans Park in Hamilton Twp. – Tennis Court Entrance
Check-in from 8:30 A.M. to 9:30 A.M.
Race starts at 10:00 A.M.

Race will be held on the beautiful Mercer County Championship course at Veterans Park in Hamilton Twp. Course consists of grass, trails and pavement. Water stops at half way point. Medals awarded to top 3 male and female runners in each age group.
Pre-entries must be received by June 1, 2010, or you may register the day of the race. Pre-race entries are guaranteed a Jim Hegedus Memorial Run T-shirt; race day entries are limited to while supplies last.

Entry Fee: $18
Day of Race: $20
Entry Form
Name: ________________________Phone________________
Age_______ Male_____ Female______
Address: __________________________

T-shirt size:

___S ___M___L___XL E-Mail_____________________________________
Waiver: In consideration of your acceptance of this entry, I hereby for myself, my heirs, my executors and administrators waive any and all rights and claims for damages I may have against the organizers of this event, and hold them harmless from any injury suffered in this event. Also, the organizers will not be held responsible for the loss of personal items nor any other form of aggravation in connection with this event. I have been warned that I must be in good health to participate in this event. By signing this waiver you are giving consent to use pictures taken at the race for website.

Signature: _______________________
Signature of parent or guardian under18:_____________________________

Please mail this form, along with check payable to “Jim Hegedus Memorial 5K” to:
Jim Hegedus Memorial 5K Run
109 Longwood Dr.
Groveville, N.J. 08620
If you have any questions feel free to call: (609)585-3290 or (609)888-2619