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EJ AUTISM FOUNDATION’S 9th ANNUAL
JIGSAW 4 MILE RUN/WALK FOR AUTISM
SUNDAY, APRIL 26, 2015 • 9:30 AM
EAST ISLIP MARINA, EAST ISLIP, NY
(at the end of Bayview Avenue)
6th Annual RACE WITHIN A RACE featuring the
JOHN MCGORRY IRISH MILE! (1.27)
1st male and female to reach the 1.27 mark will receive a Runner’s Edge Gift Card!
*4 mile FAST and FURIOUS LITF Sanctioned with
Lead Pack Escorts on Marked Course!
AboutEJAutismFoundation
The EJ Autism Foundation was set up in honor of our sons, Eric and Jack, diagnosed with Autism. Its mission
is
to increase public awareness and to provide funding for Autism programs that work directly with children on
the
Autism Spectrum. To read how EJ gives back, please visit us at
www.ejautismfoundation.org.
Post event part y immediat ely following race at Jackson Hall, 3 3 5 E main St , East
Islip, NY
Registration and fundraising opportunities available at www.ejautismfoundation.org
Raise $50 for EJ and be automatically entered for a chance to win a
$500 target gift card!! See website for details!
$25 pre-registration by mail • $25 on-line registration • $30 day of the race
*see website for details
GET THE TIME OF YOUR LIFE!
4-Mile Individual Run/Walk
1/4-Mile Kiddie Run - Starts at 9 am
Teacher
Name_____________________________________________________________________________
Address___________________________________________________________________________
City
Age (on race day)
State
Date of Birth
Zip
Sex
Email Address:_______________________________________________________________________
Signature
(Parent signature if runner is 18 years or younger)
Date
In consideration of accepting this entry, I the signatory above, intending to be legally bound, hereby, for myself, my heirs, executers and administrators, waive and release any and all rights and claims for damages I may have against the EJ Autism Foundation, Massapequa Road Runners
Club, Suffolk County, Town of Islip, Suffolk Police Department, East Islip Marina and its tenants, East Islip Fire Department, Suffolk
Transportation, Long Island Track and Field, JMS Racing Services, and their agents, employees and representatives, all volunteers and race
sponsors, for any and all damages and injuries suffered by me in this event, whether or not caused in whole or in part by the fault or negligence
of any of the above organizations or individuals. I attest and verify that I am physically fit and have sufficiently trained for the completion of
this event and my condition has been verified by a licensed doctor. I hereby grant permission to any and all of the forgoing to use any photographs, video tapes, motion pictures, recordings, or any other record of this event for any purpose.
Race Entry Fee Donation Total
Enclosed is my $50 I raised for Automatic Entry for the $500 Target Gift Card Raffle
PRESENTED BY EJ AUTISM FOUNDATION
WWW.EJAUTISMFOUNDATION.ORG
EJ Autism Foundation, P.O. Box 464, East Islip, NY 11730
T h e J o h n M c G o r r y Ir i s h M i l e i s a 1 . 2 7 M i l e R a c e w i t h i n o u r J i g s a w
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r e m e m b e r i n s p i r i t a n d c o m p e t i t i o n . A w a r d s g o t o t h e fl r s t M a l e
a n d F e m a l e a n d fl r s t M a s t e r s M a l e a n d F e m a l e t o r e a c h t h e
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c a n w i n t h e m i l e a n d c l a i m y o u r p r i z e e v e n i f y o u fl n i s h J i g s a w i n
l a s t p l a c e ! ) T h e r e i s n o s e p a r a t e r e g i s t r a t i o n f o r T h e Ir i s h M i l e .
A l l J i g s a w r e g i s t r a n t s a r e e l i g i b l e t o p a r t i c i p a t e i n T h e Ir i s h M i l e .