The Date Has CHANGED
6th Annual 5K Run/Walk-a-thon
November 15, 2008 10:00 AM
Domestic & Sexual Violence
Pelham, Hudson, Salem, and Windham Police Departments
have joined together to raise money for the victims and survivors
of domestic and sexual assault.
The race will begin at the Pelham Police Department, 14 Village Green, Pelham, NH.
Pre-Registration at the Pelham Police Department
For more information: www.pelhampolice.com, or contact
Sergeant Anne T. Perriello at (603) 635-2411.
Proceeds will cover the cost of the race and benefit “A Safe Place” Salem, NH and
“Bridges” domestic and sexual assault support services, Nashua, NH.
The first 100 registered participants will receive a free T-Shirt
Release/waiver: I hereby for myself, my heirs, executors, and administrators, waive and release any and all claims for damages I may
have against the sponsors, coordinating groups, race directors, and any individual associated with the event, their representatives,
successors and assigns, and will hold them harmless for any and all injuries suffered in connection with this event. I also agree that
the Town of Pelham, Hudson, Salem, and Windham, NH and all of its officers and representatives shall be free from any and all
liabilities or claims arising by injuries to anyone during the conduct of this event. I attest that I am physically fit to compete in this
event. Further, I hereby grant full permission to any and all of foregoing to use my likeness in all media including photographs,
pictures, recordings or any other record of this event for any legitimate purpose.
Please fill out the information completely:
Address: Gender: ______________
City: State: Zip Code:
Club Name: Phone #:
Registration $20.00 (Additional sponsor/donations are encouraged)
For Official Use Only
Parent signature if under 18
Mail to: Attn: Road Race, Pelham Police
14 Village Green, Pelham, NH 03076
Make Checks Payable to – P.P.R.A.- D.V. Race
ALL PROCEEDS WILL COVER THE
COST OF THE RACE AND WILL BE
BETWEEN “A SAFE PLACE,”
SALEM, NH AND “BRIDGES,”
SPONSOR (OPTIONAL) DONATION
PLEASE MAKE CHECKS PAYABLE TO: PPRA
(Pelham Police Relief Association)
The Date has CHANGED
Domestic & Sexual Violence
November 15, 2008 at 10:00 AM
Pelham Police Department
14 Village Green, Pelham, NH
All proceeds will cover the cost of the race and benefit “A Safe Place” in Salem, NH and
“Bridges,” domestic and sexual assault support services in Nashua, NH.
UNITED AGAINST DOMESTIC VIOLENCE
Pelham, Hudson, Salem, Windham Police Departments
have joined together to raise money for victims and survivors of
domestic and sexual assault.
The first 100 registered participants will receive a free T-Shirt.
For more information: www.pelhampolice.com, or contact Sergeant Anne Perriello at 603-635-2411