5K Run/Walk-a-thon by x1TQAP

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									               The Date Has CHANGED
            6th Annual 5K Run/Walk-a-thon
                        November 15, 2008 10:00 AM
                    United Against
               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:
Name:                                                                                       Age:
Address:                                                                                    Gender: ______________
City:                                         State:                                        Zip Code:
Club Name:                                                                                  Phone #:

Registration $20.00 (Additional sponsor/donations are encouraged)
Signature
                                                                                                         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
             EQUALLY DISTRIBUTED
           BETWEEN “A SAFE PLACE,”
           SALEM, NH AND “BRIDGES,”
                  NASHUA, NH.

SPONSOR (OPTIONAL)                      DONATION




     PLEASE MAKE CHECKS PAYABLE TO: PPRA
           (Pelham Police Relief Association)
    The Date has CHANGED
5K Run/Walk-a-thon
           United Against
      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

								
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