11th ANNUAL

WILLIAM G. ROHRER

CENTER FOR HEALTHFITNESS

5k ROAD RACE / 1 Mile FUN WALK

Proceeds Benefiting Fox Chase Cancer Program

SEPTEMBER 25, 2011

WHEN: September 25, 2011

Start of 1 Mile fun Walk - 8:30 am

Start of 5K Road Race - 9:00 am

WHERE: William G. Rohrer Center for Health Fitness

2309 Evesham Road

Voorhees, NJ 08043

Located at the West Jersey Hosptial Campus

COURSE: Course is mainly behind the Fitness Center - flat course with 1 or 2 hills

ENTRY FEE:

5k Race: $20 pre-registration and $25 on race day

5k Team Race: same as above

1 Mile Run: $15 pre-registration and $20 Race day

CONTACT: Jaime Wood 856-325-5328 or jwood@virtua.org

AWARD CATEGORIES: (5k only)

First Male & Female

First Overall Team

Top three finishers in the following age groups:

14 and under, 15-19, 20-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60+

Special Awards

Top Male & Female Virtua Employee

Top Male & Female Emergency Response Professional (Police Officers, Firefighters, EMT, and Paramedic)

Directions:

From South Jersey: Take Route 295 North to Route 561 (Haddonfield-Berlin Rd., Cherry Hill). Turn right at top of ramp and proceed to Evesham Road. Turn left on Evesham Road. Building will be on your right, after the Virtua West Jersey Hospital.

From Ben Franklin Bridge: Follow signs for Route 676 South, which becomes Route 76 East. Proceed on Route 76 to exit 295 North. Follow directions from South Jersey.

*****************************************************

Name _____________________________________ Phone ___________________

Age ______ Sex ______

Address ____________________________________________________________

City ______________________________ State _______ Zip Code __________

Please check one of the following:

___ 5k ___ 1 Mile ____ Emergency Response Prof. ___ Virtua Employeee ___ Team Challenge(maximum of 5)

Teamname _______________________________________

T-Shirt size: S ___ M ___ L ____ XL ____ XXL ___

x__________________________________________ Date _________________

In consideration of your accepting this entry, and granting of the right to participate in this event, I the undersigned, intending to be legally bound, hereby, for myself, my heirs, personal representatives, successors and assigns, waive and release any and all claims for losses and damages I may have against the WGR Center for HealthFitness, sponsors, event committee volunteers, L&M Sports for their representatives, successors and assigns and/or any other person whosoever for any and all injuries, illnesses, including death, that may result from my participation in said event. I represent and affirm that I am in proper physical condition to participate in this event, and verified by a licensed physician, and have sufficiently trained for the completion of this event. The undersigned has read and voluntarily signed this release and waiver.

Make checks payable to: W.G.R. Center for Healthfitness

Mail Application & Checks to:

WGR Center for Healthfitness

2309 Evesham Rd

Voorhees, NJ 08043

Attn: 5k Race