FAF APPLEKNOCKER RUN 2OT35K , I illru Rutrr, & IOO vp pasn

SAruRoAy, SEprrMeER 28, 2013. FHS PARKING LOT FLoRA, Ir-r-ruors

wn,xenswe,come, EARN yoUR DUI4pIING!NeuE PgoNE

GIiNDER: M / F

ADDRF:ss Crrv Srarr Zrp EMAII, ADDRESS AGE ou Dars or RUN (crRCLE oNE)

Waiverl By signing below, I do hereby release and discharge from liability the Flora Academic Foundation and the City of Flora,

organizers, event sponsors, supenrisors of the "FAF Appleknocker Run" and their representatives, successors and assigns for

any and all causes of action, claims, and injuries suffered by me in this etrent, houpver incurred. I attest and verify that I have

sufficiently trained for the completion of this event. As a parent or guardian of the applicant (if applicant under the age of 1 8),

I hereby consent to the participa.tion o{ the applicant in the race under the above mentioned conditions-

Signature_--_- _ Date________

*PnfnfetSTRATI0IV: If entry forms rcceived on or by sept ts -- llffle fioSame Day Registration Available -- f trtflg $I2

SK: $tS

str: $zo

*I{o Rrrunos

DUE To Wr,errrn

roo yard dashr FREE for childrcn I years old and under

I{Eltr - z AGE CATEG0RIE$ 4 & under DASH & s-8 year old DASH

I{o shirt provided & I{o rcgistraUon rcquircd for dashers

All participants in the roo yatd dash will receive a ribbon

Computerized Timing Services by Larry B. Ilrilliams, A Time For Everything

Final registraUon.begins in front of FIIS at741 Ait{ the day of the rrce and closes at 8r5 AIt{

sK & r ltIile runs hgin at 85O Aff in front of Flora High Sc. hool - DASHES immodiately preceding

Those pre-registered by Sept. rgth fot SK and r trIile are assured of receiving a lt{oisture lilanagement T-shirt.

Extra shirts will be ordered but will be available only,,rvhile supplies Iast

CATEG0RT: AGE CATEGoRT (CrnCrr One)

SK Rur: ro & under, u-15, t6-r8; rg-24; 2834; SS-44; 45-54; SS & older

r.[Inr nur: I & unde4 g-l; rz-t1; 16-19; 2o-zgi Soig; 40-49; 5o & older

PlEAs[ crRcrr roun your{ srzE: Sulrr ]t{EDroi{ IARGE

T-srrrr srzEE ADurr srzr: Suerr -UEDru.u Lancr X-lancr *XXL *nno Sz

it{nlt zytny r0ni{ To: Flora Academic Foundation, Att lt{elanie Pearce, rz5 lincoln Ave., Flora, lL 6z8sg

0R Dnop oFF AT: FCUSD *55 Unit 0ffice,444 South locust, Flora,Il6zB3g

0rHER coryTAcr rr{F0ntrATr0r{: Bear'.c_el,avj9,m$ee-srt 0R clct (at) so8-27s5 on FacrsooK pAcE: FAF Appl:KilocKER Ruil

*PIEASE AVOID PARKII{G II{ THE II{AIIf FHS PARKIIYG TOT (IifAIT{ FESI TAI SITE) AI{D WEST SIDE OF SCHOOI (RACE SITE).