Eye Run for Vision 5K Run/Walk Official Entry Form

Name: ________________________________________________________________________________

Address:_____________________________________________________________________________

City, State, Zip:_________________________________________________________________________

Phone:______________________________________________________

email: ________________________________________________________________@_________________________________

Sex:_____________Age on Race Day:____________

Race Division (check one only):

5K Run _________ 5K Walk_________

Team Information (optional)

Team Name: __________________________________________________________________

Team Leader: __________________________________________________________________

Entry Fee:

________$20 Pre-registration with T-Shirt - Postmarked by 8/29/08

________ $25 Race-Day or Postmarked afer 8/29/08

How did you hear about our event? Please circle one:

_____I am a Luxottica Retail Associate

_____I am a family member or friend of a Luxottica Retail Associate

_____Other Race or Race Website

_____Other

T-Shirt size: (circle one ) S, M, L, XL, XXL

Make checks payable to: Give the Gift of Sight Foundation
Send to: Greg McCormick, 10119 Crosier Lane, Cincinnati, OH 45242
(Pre-registrations should be postmarked by August 29, 2008)

On behalf of myself, my heirs, executors, estate, successors and assigns, I hereby release and hold harmless all sponsors, affiliates, managers, coordinating groups, volunteers, race director and all other individuals, groups and entities associated with this event, as well as their affiliates, agents, employees, directors, officers and members, from all claims which may arise from or as a result of my participation in the Eye Run For Vision race. In consideration of the acceptance of my entry and my participation in this event, I understand and agree to assume all risks of my participation. I understand and agree that my name and picture or photograph of my participation in this event may be used for results and publicity purposes.

FOR PARTICIPANTS UNDER AGE 18:This certifies that my son/daughter has my permission to participate in the Eye Run For Vision and event officials have my permission to authorize emergency treatment if necessary. (please print, sign, and turn in to registration table at the Walk.)

IMPORTANT: PARTICIPANTS UNDER AGE 18 MUST HAVE THIS FORM AGREED TO BY A PARENT OR GUARDIAN!

ENTRY SIGNATURE:_____________________________________________Date: __________________

Parent's Signature (if under 18): ____________________________________Date: ___________________

Emergency Contact: __________________________________________Phone________________________

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