T-Con Memorial 5K / 1 Mile Walk (Teresa Conti) Registration Form
Make checks payable to:	Teresa Conti Memorial Scholarship Fund
Print this form, fill it out and send to:	Tony Conti 1158 Ledgebrook Drive Tallmadge, OH 44278

Name Address City, State, Zip Day Phone Evening Phone Email Address Age on 7/16/2011 Sex   Select Event    ___  Walk: 8:30 AM    ___  5K Run: 9:00 AM Select Age Division    5K    ___  14-under    ___  15-19    ___  20-24    ___  25-29    ___  30-34    ___  35-39    ___  40-44    ___  45-49    ___  50-54    ___  55-59    ___  60-over   Circle Shirt Size    Race T-Shirt:    Small      Medium      Large      X Large      XX Large      Entry Fees    Walk or Run before 7/7/11 (includes T-shirt): $15    Walk or Run after 7/7/11 (T-shirt, if available): $20    Race Day:(T-shirt, if available): $20    High School Cross Country Runners (T-shirt, if available), $10   In consideration of the acceptance of my entry, I, for myself, my executors, administrators, and assignees, do hereby release and discharge the T-Con Memorial 5K Run and any other sponsors and officials for all claims of damages, demands, or actions, whatsoever in any matter arriving or growing out of my participation in said athletic event.   Participant's signature Date   Guardian's signature, if participant is under 18 Date

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