Final ENTRYFORM

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					                         “Takbo para sa Puso”
                       Doc Fit Advocacy Program
                      Philippine Heart Association
1.    DATE                                                                   ***CASH PRIZES ALSO AWAITS TOP AGE GROUP
         25 May 2008, Sunday                                                 FINISHERS (OVERALL TOP 10 WINNERS shall not
                                                                             be eligible anymore to these cash prizes)                       WAIVER OF LIABILITY
2.    VENUE
         Start/Finish Area in front of UP Theater along the               All winners (overall top ten and age category) will receive
         Academic Oval, UP Diliman                                                                                                           By signing the Entry Form and participating in the PHA FUN RUN,
                                                                          trophies/medals, certificates, and gift packs.                     I agree to abide by the rules of this event and certify that I am
3.    TIME                                                                                                                                   physically fit and adequately trained to finish the race and that I
                                                                          All finishers will receive a certificate of completion and gift    fully accept the following Waiver of Liability:
         Assembly: 5:00 AM                                                pack.
         Start of Race: 6:00 AM
                                                                                                                                             I understand that participating in this event may involve real risk of
4.    ENTRY FEE                                                      7.    WINNERS’ AGE VERIFICATION                                         serious injury or even death from various causes including but not
         Entry fee for all participants is PhP 100 and is not                                                                                limited to falls, over exertion, dehydration, contact with other
         refundable                                                             All top finishers in all age group categories must           participants, spectators, road users, effect of weather and
                                                                                produce a valid identification card (e.g. PRC, driver’s      conditions of the road. I voluntarily assume all risk associated with
5.     RULES AND REGULATIONS                                                    license, passport) or a photocopy of birth certificate for   my participation in the event or any activity associated with it.
     a. Both MD and non-MD category for 5K and 10K                              age verification at the Technical Secretariat Center.
          running event are open to all running enthusiast aged                                                                              I, in consideration of and as a condition of the acceptance of this
                                                                     8.    COLLECTION OF T-shirts & RACE KITS                                entry for my self, my executors, administrators, heirs, next of kin
          15 years old and above.
     b. MD age categories for both male and female for the 5                    Participants may claim their race kits (containing the       hereby waive, release and forever discharge the event
          and 10K event are as follows: <30, 31-40, 41-50,51-                   official race number, safety pins and route map) and T-      organizers, sponsors, promoters, agents or servants from all
          60 and >60 years old.                                                 shirt upon submission of their registration forms and        claims, actions or damages that I may have against them
     c. Non-MD age categories for both male and female for                      payment of entrance fees.                                    howsoever cause, arising out of or in any way connected with my
          the 5 and 10-K event are as follows: <20, 21-30, 31-                                                                               participation in this event.
          40, 41-50, 51-60 and >60 years old.                        9.    WATER & FIRST AID STATIONS
     d. Participants below 18 years old must have their entry                                                                                I authorize the use of my name, voice and picture and any
                                                                                Drinking water will be provided every 2.5 km along the       information provided by my self on this entry form to be used
          form signed by a parent/guardian.                                     race track and at the finish line. Medical aid will be
     e. Race bib numbers must be worn at all times during the                                                                                without payment in any broadcast, telecast, promotion or
                                                                                available at certain strategic points along the race         advertising. I also agree that the information that I have provided
          race. It should be pinned in front of your running shirt              track and at the finish line.
     f.   All protest related to the results must be made in                                                                                 may be used by the event organizer for the purpose of promoting
          writing and submitted to the Race Organizer within 30      10. TOILET AREA                                                         future and other events for the promotion of face sponsors,
          minutes after the official announcement of winners. A                                                                              products and services.
          PROTEST FEE of PhP 2000 will be collected for                         Toilet cubicles will be available at designated areas
          every written protest made.                                           during the race.                                             _________________________________________
     g. The organizer’s decision is final                                                                                                    Signature over printed name
                                                                     11. PARKING AREA
6.    PRIZES                                                                    All participants and other spectators are required to        _________________________________________
       A. TOP 10 OVERALL FINISHERS (for both MD and non                         park their vehicles at the allocated parking areas.          Parent’s Signature for Participants below 18 years old
       MD category and for both Men’s and Women’s division)                     Please refer to the Map provided.
                                                                                                                                             _________________________________________
       5K                                  10K                       12. BAGGAGE AREA
                                                                                                                                             Date
       1st prize: P8,000                   1st prize: P12,000                   Baggage deposit service is available near the Stage
       2nd prize: P5,000                   2nd prize: P8,000                    from 5:00 AM to 11:00 AM.
       3rd prize: P3,000                   3rd prize: P 5,500
       4th-10th prize: P1,000              4th-10 th prize: P2,000
ENTRY FORM                                 o MD             Date : _________________   ___ Above 60
                                                            60



Non-refundable Entry Fee: P100
                                           o Non-MD
Bib No _________________
Name
___________________________________________________
Address____________________________________________
___________________________________________________
                                                                                                         With the generous support of our friendly Pharmaceutical
Date of Birth                                                                                            company:
_________________________________________                                                                                             a

Age __    (verified through submission of the ff:
           o PRC o Driver’s o Birth certificate o Others)   DOC FIT fun run program committee:
                                                                                                                                                         f
Gender:
  __ Male                      __ Female                    Overall Chairman: Dr. Liberty Yaneza
School/University/Company
                                                            Co-Chairman: Dr. Roland de los Reyes                              presents:
___________________________________________________
___________________________________________________
                                                            Logistics Head: Dr. Roland de los Reyes
Hospital/Associations/Organizations                                                                                 “Takbo para sa Puso”
___________________________________________________         Registration Head: Dr. Eduardo Tin Hay
___________________________________________________                                                                  A PHA fun run event
Mobile Phone: _______________                               Advertising Head
Landline:
__________________________________________________
                                                                                                                                                   25 May 2008
                                                                     For MM: Dr. Marian Almajar                                                 Sunday, 5:00 AM
Email address                                                        For provincial: Dr. Nestor Bagsit                                              UP Theater,
___________________________________________________
                                                                                                                                                    UP Diliman
DISTANCE CATEGORY:               AGE CATEGORY (MD)
                                                            Awards/Prizes chairman: Dr. Edgar Tuazon                                                           Contact
(Check one)                      Check one                                                                                      Philippine Heart Association Secretariat
___ 5km Open Category            ___ 30 and below           Support Systems/event-coordination Head:                    (632) 929-1161, (632) 929-1166, (632)929-1173
____10km Open category           ___ 31 to 40                                                                                                      Mobile 09167024338
                                 ___ 41 to 50                                                                                                      Fax: (632) 929-1165
T shirt Size:                    ___ 51 to 60
                                                                     Chair: Dr. Rodney Jimenez                                     Email : phil.heart@yahoo.com
____ S                           ___ Above 60
____ M                                                               Co-chair: Dr Eric Pascual
____ L                          AGE CATEGORY ( NON-MD)
____ XL                         Check one
                                ___ 20 and below            Event Run Organizer: Mr. Rio de la Cruz
                                ___ 21 to 30
                                ___ 31 to 40
Amount paid: P100               ___ 41 to 50
Received by: ___________        ___ 51 to 60

				
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