RUNNER REGISTRATION FORM LOS LUCHADORES 5K FUN RUN/WALK Saturday November 14, 2015 Race starts at 8:00 a.m. Race Location: Mission County Pavilions, 6030 Padre, San Antonio, TX 78214. All profits will benefit Impact SA! Impact San Antonio Foundation was founded by Kelly Hutchinson in 2004 as a women’s giving circle. Since the first grant was awarded in 2005, the organization has given $1,060,000 to San Antonio area non-profits. You may also register online at www.IFWH5k.org Entry Fees: Early registration fee $25.00 by July 31 includes Tech Shirt. After July 31 $35.00 includes Tech Shirt. On race day $40.00 Shirts are not guaranteed for race day registrants. Non Refundable! Kids Run: 1K run $15.00 inlcudes shirt if registered by November 1st but not guaranteed after that date or for race day registrants. This race is not chip timed. Non Refundable! Awards: Overall Male and Female championship belt. Awards for top 3 in each age group & gender. No award duplicates. Overall winner awards based on gun time. Age Groups: 10 & Under, 11-14, 15-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70+. Age group awards based on chip time. Chip Timing: The 5k race will be chip timed. Amenities: There will be water stops every mile and mile markers will have photo booths. After the race stay for the fiesta and enjoy some yummy eats, music, cold drinks and beer. Contests: Cash prices will be awarded to the best Luchador Mask and the most creative Luchador Costume. ENTRY FORM AND WAIVER OF LIABILITY MUST BE SIGNED TO PARTICIPATE Please make all checks payable to Los Luchadores 5k Institute For Women’s Health. Name ________________________________________________ Phone _______________ E-mail ___________________________Date of Birth _____________________ Age ___ Gender M__ F__ Address ______________________________________________________ City, State & Zip _____________________________________________________________ Shirt Size: Male S M L XL 2XL Female S M L XL 2XL Youth S M L XL RELEASE AND INDEMNIFICATION- READ BEFORE SIGNING The signing of this entry blank form and the participation in the Los Luchadores 5k Fun Run/Walk presented by Institute For Women’s Health is with full knowledge of the risks involved therein and the undersigned individually and/or as parent or guardian assumes the risk of an injury, sickness or health defect including death, resulting from or receiving during participation in the races, and further releases and agrees to save harmless Los Luchadores 5k Fun Run/Walk and Institute For Women’s Health, it’s committees, sponsoring and assisting agencies and individuals from any liability, damage, claim or judgment that may result from or arise out of the participation of the participant in this race. I grant permission to be photographed, video taped and recorded for all media usage. _______________________________ Participant Signature and Parent/Guardian if Under 18 ___________________ Date Please mail registration form to 1355 Central Parkway South, Ste. 400, San Antonio, TX 78232