2015 Color Me Green 5K/3K Run/Walk DATE: Saturday, March 28, 2015 TIME: 8:00 AM --- Registration 9:00 AM --- Start of walk/run PLACE: Durham High School, 9455 Putney Dr., Durham, CA ENTRY FEE: $10.00/per person (Includes Race T-shirt) ***Registration received after March 13, 2015 cannot be guaranteed race t-shirt*** Registration Details: COLOR ME GREEN RUN/WALK (check one): ❑ 5K Run/Walk ❑ 3K Run/Walk Runner #1: First Name: __________________________________________ Last Name: ____________________________________________ Address: _________________________________________________ City: __________________ State: ________ Zip code_______________ Phone: __________________________________________________ E-mail: _____________________________________________________ ❑ Yes Are you a current 4-H Member/Leader: ❑ No If “Yes, which 4-H Club? _____________________________________ County: ____________________________________________________ EMERGENCY CONTACT: Name: ___________________________________________________ Phone: ______________________________ Signature Runner #1: ____________________________________________________________________________________________________ Parent/Guardian signature if youth is under 18: _______________________________________________________________________________ SHIRT SIZE (Youth): ❑S ❑M ❑L ❑ XL SHIRT SIZE (Adult): ❑S ❑M ❑L ❑ XL ❑ XXL Runner #2: First Name: __________________________________________ Last Name: ____________________________________________ Address: _________________________________________________ City: __________________ State: ________ Zip code_______________ Phone: __________________________________________________ E-mail: _____________________________________________________ ❑ Yes Are you a current 4-H Member/Leader: ❑ No If “Yes, which 4-H Club? _____________________________________ County: ____________________________________________________ EMERGENCY CONTACT: Name: ___________________________________________________ Phone: ______________________________ Signature Runner #2: ____________________________________________________________________________________________________ Parent/Guardian signature if youth is under 18: _______________________________________________________________________________ SHIRT SIZE (Youth): ❑S ❑M ❑L ❑ XL SHIRT SIZE (Adult): ❑S ❑M ❑L ❑ XL ❑ XXL Please send in Entry Form, Waiver of Liability Form & Payment (Check or Money Order ONLY, payable to Butte 4-H County Council) to: Color Me Green Run, 5 Taige Way, Chico, CA 95928. FOR MORE INFORMATION CALL: 4-H Office: (530) 538-7201 Katherine Pilakowski (Youth Chair): [email protected] Nicole Marshall (Adult Chair): [email protected] Brian Marshall (Adult Chair): [email protected] In accordance with applicable State and Federal Laws and University policy, the University of California does not discriminate in any of its policies, procedures, or practices on the basis of race, religion, color, national origin, sex, marital status, sexual orientation, age, veteran status, medical condition or handicap. Inquiries regarding this policy may be addressed to the Affirmative Action Director, University of California, Agriculture and Natural Resources, 2801 Second Street, Davis, CA 95618 Phone: (530) 750-1286