1. education
2. adult education

AAMP’S Run/Walk in the Park 5K
Saturday, June 13, 2015
Race begins at 9:00AM – Kitchell Park, Pana IL
All runners and walkers are welcome to participate!
ENTRY FEES
5K Run/Walk
5K Run/Walk
ADULT:
Student (K-12):
$20 thru May 25; $30 on race day
$15
RACE DAY REGISTRATION & INFORMATION
7:30AM – 8:30AM at Chautauqua Building in Kitchell Park, Pana IL
** Contact Erica Matthews for more information (217) 825-4605
SHIRTS
 Short sleeve t-shirt guaranteed to first 100 registrants by Monday, May 25th.
 Race day registrants will receive as available.
PROCEEDS
All proceeds benefit the Autism and Movement Project, a local dance therapy class designed for Autism, special needs
and any child looking to improve speech, behavioral, social and motor skills.
CHECKS PAYABLE:
Autism and Movement Project
Mail to:
Erica Matthews
507 S State St
Pana, IL 62557
**PRE-REGISTRATION IS RECOMMENDED
ENTRY FORM/WAIVER (Please Print)
(circle one) Male Female
Last Name
First Name
Street Address
City
MI
State
Zip
Phone Number
Email:
Birthdate
Age on Race Day
RACE ENTERING: (circle one)
5K Run
5K Walk
T-Shirt Size: (circle one)
Youth- Small
Med
Large
Adult- Small
Med
Large
XL
XXL
WAIVER – (Please read carefully)
Waiver of legal liability: By signing below, I for myself, my executors, administrators and assignees do hereby release and discharge from liability
the City of Pana, County of Christian, State of Illinois, Autism and Movement Project, all sponsors, timers, directors and volunteers, and organizers
of the AAMP 5K Run/Walk, all other persons associated with the event or otherwise, and their representatives, successors and assignees for any
and all injuries suffered by me in this event, however incurred or sustained. I attest and verify that I have knowledge of the risks involved in this
event and I am physically fit and sufficiently trained to participate in the event. All persons under the age of 18 must have parent or guardian
signature.
Signature
Date