Application: LACKAWANNA FIRE 50005K race /walk
Friday September 3rd 2010 6:30 pm start
Holy Cross Cemetery, South Park entrance
USATF certified

Awards
Post Race Awards Party :




Overall 1st Male, 1st female
Knights of Columbus




Standard 5 year age groups
2838 South Park, Lackawanna
1st-3rd through 70+
Near finish line




Emergency Teams Award
food, drinks, music, awards



1st -3rd fire / police/ ems teams











(Best three times on team)

Race and walk Start at 6:30 near South Park entrance to Holy cross Cemetery. Fire Departments, Law Enforcement
Agencies and Emergency Services Workers encouraged to compete, as a group. Proceeds benefit the Burn Foundation

Packet pick up:
Sept 2nd from 3pm -6pm @ Lackawanna Fire Station , 2990 South Park, Lackawanna
Sept 3rd from 4:30-6:15 @ Knights of Columbus 2838 South Park

Mail completed registration to: Lackawanna Fire 5000 P.O.Box 35 Lackawanna , NY 14218.
Postmarked by 8-21 to guarantee t-shirt, otherwise limited to supply at hand.

Return below section ----------------------------------------------------------------------------------------------------------------------

Checks payable to: Lackawanna Fire 5000 20$ pre-register 25$ day of (U.S. funds)




I am participating as: ____An individual


____A team Team Name ___________________________________

Name_______________________________________M_____ F_____ T-shirt: S M L XL XXL

Address__________________________________City _________________State_________ZIP__________

Phone___________________ Age on race day______ e-mail___________________________________

In consideration of the entry being accepted, and participating , I for myself, my heirs, executers, and administrators, forever
discharge all claims for injury or loss against the Lackawanna Fire 5000, the City of Lackawanna, all organizations involved
and all sponsors of the race. I declare myself physically fit to race.


_______________________________________________ _____________________________________________
Signature





Parents Signature if under 18 yrs old


THANKS TO ALL OF OUR SPONSORS WHO HELPED MAKE THIS RACE POSSIBLE!

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