Text Box: Last Name____________________________ First Name____________________________ Address_______________________________ Zip Code_____________ Birth date___/__/___ Age_____Sex:_M or F_____ Phone_(____)___-_____________ Text Box: ENTRY FEE: PRE-REGISTRATION DUE BY AUGUST 2nd, 2008 $15.00 PRE-REGISTRATION AND OR FIRST 175PARTICPANTS WILL BE GUARANTEED SHIRTS FEE ON RACE DAY $20.00 MILE FUN RUN WITHOUT SHIRT $3.00 SHIRT SIZE/ CIRCLE ONE: ADULT SMALL MEDIUM LARGE X-L CHILD : MEDIUM LARGE Text Box: I HEREBY RELEASE THE VILLAGE OF LEXINGTON AND ALL INDIVIDUALS OR ORGANIZATIONS ASSOCIATED WITH THE 5K RUN/WALK AND MILE RUN FROM ALL RESPONSIBILITY AND OR LIABILITY FOR ANY LOSSES, INJURIES OR ACCIDENTS I INCUR IN CONNECTION WITH THIS EVENT. _________________________________/______ _________________________________________/______ PARTICIPANT’S SIGNATURE DATE PARENT’ SIGNATURE DATE (MINORS) Text Box: 5K Start time 9:00 a.m. Text Box: PLEASE RETURN THE ABOVE FORM AND PAYMENT TO: LISA SHAW VILLAGE 5K 6861 COUNTY FARM LEXINGTON, MI 48450 (810)359-3379 MAKE CHECKS PAYABLE TO CROS-LEX ATHLETICS THE RACE BEGINS IN FRONT OF THE LIONS HALL HURON AVE. SATURDAY AUGUST 16th, 2008 Text Box: CIRCLE ONE: 5K RUN/WALK MILE FUN RUN

Emergency Phone Number (_____) ____-_______

Mile Fun Run 8:40 a.m.