R E G I S T R A T I O N F O R M

Pine Hill Education Foundation 5k

1 Mile Run/Walk

Motorcycle Poker Run

O c t o b e r 1 1, 2 0 0 8

Name ____________________________________________________________

Age on 10/11/08 __________ Sex ________

Address __________________________________________________________

City ________________________________ State ______ Zip _______________

Email _______________________________

Phone ____________________ Amount __________ Check # ________

TShirt Size _____ (S, M, L, XL)

E V E N T: 5k ____ 1 Mi. Run/Walk ____ Motorcycle Poker Run ____

RELEASE

I, the undersigned acknowledge that a road race is a potentially hazardous activity. I certify that I am mediacally able and have sufficently trained for this event. I agree to abide by all decisions of the race as final. In consideration of the acceptance of my entry and intending to be legally bound, i do hereby for myself, and anyone entitled to act on my behalf, waive, release, and discharge The Inter-Community Celebration Association, its officers, employees, and the borough of Berlin/Berlin Twp., and all other sponsors and participants from any and all liabilities arising out of my participation in this event.

____________________________________________________________

Signature of Adult or Parent if racer is under 18

Make checks payable to the "Pine Hill Education Foundation" and return both to:

Pine Hill Education Foundation

Run, Ride, or Walk for Education

1003 Turnerville Road

Pine Hill, NJ 08021