Essex County Cherry Blossom 10K Run by yurtgc548


									     2011  OFFICIAL  ENTRY  FORM                                                                                       Essex  County  Cherry  Blossom  10K  Run
       Please make checks payable to “Cherry Blossom Run.”
                                                                                                                                            Essex County Branch Brook Park, Newark
                                                                                                                                            Essex County Branch Brook Park Newark
       10K                     Disabled                       Gender                   Race Day Age                                                  Sunday, April 10, 2011
                                                                                                                              $18 Pre-Registrants; $16 USATF-NJ Member Pre-Registrants; $20 General
Last Name                                                         First Name                            M.I.
                                                                                                                                                                            RACE  DAY                               AWARDS/GIFTS
                                                                                                                              PACKET  PICK‐UP
                (Inc Apt
Mailing Address (Inc. Apt. #)                                                                                                                                                 8:00am – 9:45am
                                                                                                                               April 8 from 10am to 4pm                                                               First 500 Registrants
                                                                                                                                                                                 Registration                         Long-Sleeved Shirts
                                                                                                                              115 Clifton Avenue, Newark
City, State and ZIP Code                                                                                                                                                          9:00am                     Top 3 Overall Finishers (Male & Female)
                                                                                                                                                                           One-Mile Fun Run Start
                                                                                                                                                                           O Mil F R St t                            Certificates Fleece J k t
                                                                                                                                                                                                                Gift C tifi t & Fl        Jackets
                                                                                                                              April 10 from 8am to 9:45am
Phone                                                                                                                      Cherry Blossom Center Parking Lot                      10:00am                     Top 3 Finishers in Each Age Category*
                                                                                                                        Essex County Branch Brook Park, Newark                    10K Start                               Fleece Jackets

E-mail                                                                                                                                                                                                        Top 3 Overall Disabled Run Finishers
                                                                                                                                                                                 10:10am                                Fleece Jackets
                                                                              S        M         L        XL
                                                                                                                                    PARKING                                    Disabled Start
Date of Birth                                                            T-Shirt Size (Circle One)                            Clara Maass Medical Center                          11am                            $2 per entry will be donated to
                                                                                                                              5 Franklin Avenue, Belleville                Award Announcements                    Special Olympics New Jersey!
USATF-NJ#                                                           Personal ChampionChip #
                                                                                                                                 * Age categories are: 14 and under; 15-19; 20-29; 30-39; 40-49; 50-59; 60-69; 70-79; 80 and over; Stroller
                                                                 The                    Run I,      heirs, executor,
In consideration of the acceptance of my application to enter "The Cherry Blossom Run" I my heirs executor
administrator, successor, and assigns, do hereby acquit and forever discharge the County of Essex and the
Department of Parks, Recreation and Cultural Affairs, USATF-NJ, CompuScore, their agents, servants,
successors, heirs, executors, administrators, and all other persons or entities involved in the promoting or staging
                                                                                                                                                  All pre-registrations must be post-marked or hand-delivered by Thursday, March 30, 2011 to the
of the aforementioned race from any and all claims, causes of action, demands, rights, damages, costs, loss of                                    Essex County Park System Cherry Blossom Run, 115 Clifton Avenue, Newark, NJ 07104. Online
services, expenses, and compensation which the undersigned may hereafter accrue of or in unforeseen damage
and consequences resulting or to result from the undersigned's participation in "The Cherry Blossom Run" which                                    registration is available at and, ending Sunday, April 3rd. The
is to be held on Sunday, April 10, 2011, in Newark, New Jersey. I also give my permission for the use of my
name and/or picture in any newspaper, broadcast, telecast or other account of this event.
                                                                                                                                                                               ChampionChip.                                  ChampionChip,
                                                                                                                                                  race will be timed using ChampionChip If you do not have a personal ChampionChip one will be
                                                                                                                                                  provided to you; however, a $20 replacement fee will be charged to those who do not return those chips at
                                                                                                                                                  the end of the race. Information on the One-Mile Fun Run can be obtained by visiting
                                                                                                                                         or calling 973.239.7072.
Signature OR Parent/Guardian Signature (if under 18)                                                 Date
  County of Essex
  Parks, Reecreation and Cultural Affairs
  115 Clifton Avenue
  Newark, NJ 07104
  973.268.33500 /

       ph          nzo,
   Josep N. DiVincen Jr.

                                   N       cenzo, Jr.
                            Joseph N. DiVinc
                                   C       xecutive
                             Essex County Ex
                                            and the
                          B        C       reeholders
                          Board of Chosen Fr

                         vite  t        ipate in th
                       Inv You to Partici         he

                              ex Cou
               35th Annual Esse    unty 

E   X            CH ROOK PARK
        UNTY BRANC BR       K

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