Entry form

2015
F.A.R.M.
Food Allergy Resources & Mentoring
5K Run / Walk
Nature vs. Nurture
F.A.R.M. 5K Run/Walk
“Nature vs. Nurture”
Ritch Grissom Memorial Wetlands, 10001 N Wickham Rd, Melbourne, FL 32940
DAY OF RACE SCHEDULE:
AMENITIES:
Saturday, Aug 15th
• 6:30 am Day of Race Registration Opens
• 6:30 am Pre-registered Packet Pickup
• 7:30 am 5K Race Start!
*Awards Ceremony immediately following race (Approximately 9:00 am)
• Soft Blend T-shirts
• Replacement Fluids & Refreshments
• Awesome Awards
• Unique Location
*Register Online at www.fa-resources.org/events
AWARDS:
EARLY REGISTRATION:
Soft Blend T-Shirts guaranteed to pre-registered participants.
Unique Awards
Top 3 Overall M & F, Top Masters (40+)
Age Groups (Top 3 M & F)
8 & Under 9-11 12-14 15-19
20-24 25-29 30-34 35-39
40-44 45-49 50-54 55-59
60-64 65-69 70-74 75+
• April 10 – August 7: $23 (Students under 12 – $15)
• August 8 – August 14: $28 (Students under 12 – $20)
• Day of race: $30.00 (Students under 12 – $20)
SORRY, NO REFUNDS
COURSE:
Ritch Grissom Memorial Wetlands. The 5k course is a one loop run
though native Floridian wildlife and very scenic. The course is a very
well maintained hard packed dirt trail.
Proceeds benefit Food Allergy Resources & Mentoring.
FARM’s mission is to create public awareness of the growing food allergy
epidemic and provide a voice to those with food allergies. Today, 1 in 13 kids
suffer with food allergies. That’s roughly 2 in every classroom! Through FARM’s
outreach and community events, they provide socially inclusive atmospheres
that foster friendship and community support to those who suffer in isolation.
FARM was founded in 2014 by two parents with a child who suffers with a life
threatening milk allergy. It is through their personal journey that they are able
to see and fill the void in community support for food allergies.
DIRECTIONS:
Nature vs. Nurture 5K OFFICIAL ENTRY FORM
Send completed entry form with fee to:
274 E. Eau Gallie Blvd. STE. 365 Indian Harbour Beach, FL 32937
Make check payable to: Food Allergy Resources & Mentoring
Name__________________________________________________ Sex: Male Female
Address ________________________________________________
City ___________________________________________________ State _______ Zip __________
From I-95 take exit 191 Viera.
Turn West onto Wickham Road.
Ritch Grissom Memorial Wetlands is on the left.
CONTACT:
Food Allergy Resources & Mentoring
Telephone (808) 250-5188
[email protected]
www.fa-resources.org
Phone __________________ Email address ______________________________________
Date of Birth _____/_____/_____ Age on Race Day _____
Cotton Shirt Size: Youth: Medium Large Adult: Small Medium Large XL XXL
How did you hear about the race: Marketing Online Forum Friend Other_________________
INCOMPLETE OR UNSIGNED ENTRY FORMS WILL NOT BE ACCEPTED
In consideration of my entry being accepted, I intend to be legally bound, and hereby for myself, my heirs, and executors, waive all rights and claims for damages which may hereafter
accrue to me against the sponsors, officials, volunteers, and supporters of this race and any representatives, successors, or assigns for any and all damages or injuries which may be
sustained and suffered by me in consideration of my association with an entry or participation in the Nature vs. Nurture 5K event. If I should suffer injury or illness, I authorize the officials
of the race to use their discretion to have me transported to a medical facility, and I take full financial and legal responsibility for this action. I attest and verify that I am physically fit and
have my physician’s permission to participate in this race. I hereby grant full permission to any and all of the foregoing to use any photographs, videotapes, or any other record of this
event for any purpose of the event whatsoever. I have read the above release and understand that it presents a risk of physical injury, knowing this I am entering this event at my own risk.
________________________________________ ___________________________________________ __________
SIGNATURE SIGNATURE OF PARENT FOR THOSE UNDER 18 DATE