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
COURSE: Course is mainly behind the Fitness Center - flat course with 1 or 2 hills
ENTRY FEE:
CONTACT: Jaime Wood 856-325-5328 or jwood@virtua.org
AWARD CATEGORIES: (5k only)
Directions:
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.
WGR Center for Healthfitness
2309 Evesham Rd
Voorhees, NJ 08043
Attn: 5k Race