Pace for Peace-Hope Run 5k 10k
Saturday, April 18, 2015, 8:00AM
First Name ______Last Name______
Address ______
City______Zip ______
Email______Phone ______
Registration: Please check one
10K Run$35 ______5K Run$30 ______5K Fun Run/Walk$30______
5K / 10K Students under 18 $20______
Payments: Online at: trivalleyhaven.org. Click the Registration Link
Mail check(s) with form: payable to Tri Valley Havenby April 8th.
Complete form and collect pledges and mail by April 8st or bring to registration desk on race day
Credit Card Payment: VISA_____ MC _____ AMEX _____
Name on Card ______Card #______
Signature______Exp Date ______Code______
T-Shirt $5 Male___ Youth ___ S M L XL XXL
Female ___ Adult _____ T-shirt Size
No T-Shirt _____
**Bonus gift to all registrants with additional $50.00 in pledges**
Prizes and medals *Top 3 finishers 10K and 5K Race
*Group or team with top pledges
*Top 3 Runners/Walkers with the top pledges
Waiver:
I know that running or volunteering for a road race is potentially a hazardous activity, which could cause injury or death, I willnot enter and participate unless
I am medically able and properly trained and, by my signature, I certify that I am medically able to perform in this event and that I am in good health. I agree
to abide by the rules of this race and I assume all risks associated with running in this event. Including but not limited to falls, contact with other participants,
the effects of weather, including highheat, traffic, and road conditions, all such risks being known and appreciated by me. Having read this waiver and knowing
the factsand in consideration of your accepting my entry, I for myself and anyone entitled to act on my behalf, waive and release the City of Livermore,
Tri Valley Haven and their officers, agents, volunteers, employees, all event sponsors and their representatives and successors, from all claims or liabilities of any
kind arising out of my participation in this event. I also grant permission to all of theforegoing to use any photographs, recordings, and or other record of this
event for any legitimate purpose. I acknowledge that Ihave read and understand the above.
______
Race Participant Signature Date Parent/Guardian (if under 18) Date
All Participants and Volunteers must sign this waiver to be admitted to the race
Please mail to: Tri Valley Haven – Race, 3663 Pacific Ave., Livermore, CA 94550 no later than
April 8th, or bring to registration table on day of race. Please arrive early. 925-449-5845
Please collect pledges to maximize our fundraising efforts
Donations are tax deductible: Please make checks payable to Tri Valley Haven(see back)
Please collect pledges to maximize our fundraising efforts
Donations are tax deductible: Please make checks payable to Tri Valley Haven
Name Address Phone Donation/Pledge Paid
Total Pledges $______
Please copy or use lined paper for additional pledges