Highlands Cup 5 K Run/Walk form

Oct 6th join us for the Highlands Cup 5 K Run/Walk

Highlands Cup 5K Run/ Walk Registration Form
8:00 am Saturday,October 6, 2007
You may also register and pay on www.active.com
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Send check and entry form (postmarked by 9/28/2007) to: Highlands Cup 5k, c/o HCM, 1140 Cherokee Rd., Louisville, KY 40204
I cannot participate, but please accept my donation of $

Please print
Name

Address

City

State

Zip

❑Male

❑Female

Phone

E-mail

Date of Birth

Age on Race Day

Long sleeve t shirts this year.
Shirt Size: ❑S ❑M ❑L ❑XL ❑XXL
Signature (Parent, if under 18 years old)

Date

Make checks payable to Highlands Community Ministries �EFor additional information, call 451-3695
Highlands Community Ministries
1140 Cherokee Road
Louisville, KY 40204

Entry Fee (check one)
Early Adult $22.00
Early Youth $17.00
Late (all) $25.00


Late Registration:
Monday thru Thursday (10/01-10/05),9 A.M. - 12 P.M. at HCM, 1140 Cherokee Road. Enter door off Patterson or drop form and check in mail slot at door on Patterson.
Friday, Oct.5, 4-8 P.M.: Douglass Blvd. Christian Church (2005 Douglass Blvd).

Packet pickup:
Friday, Oct.5, 4-8 P.M. at Douglass Blvd Christian (2005 Douglass Blvd.).
Race Day, 7 - 7:45 A.M. at Douglass Blvd.Christian.
This run/walk is
for Highlands Community Ministries.
Start at
8:00 am
Corner of Douglass Blvd.
& Bardstown Rd.
Step up and help our local
heroes in the Highlands who
deliver the meals on wheels,
provide daycare for the young
and elderly, and provide help
for the needy.

In consideration of the acceptance of my
entry for THE HIGHLANDS CUP 5K
RUN/WALK, I, for myself,my heirs,
executors and administrators,waive and
release all claims against The Highlands
Cup,Highlands Community Ministries,
all contractors, promoters, supporters and
volunteers, for all claims of damage,
injuries, demands, actions in any manner
as a result of my participation in THE
HIGHLANDS CUP 5K RUN/WALK.
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Thanks to Our Sponsors: Visit HighlandsWeek.org for full listing of sponsors and see the link whereby you can register and pay for the race on line.
Unique, high-quality awards

Pancake Breakfast:
Douglass Blvd. Christian Church 8:30-9:30 am to benefit
Highlands Community Ministries
$5.00-adults
$4.00-race participants
$3.00-14 and under
Tickets will be sold at the door.

Form