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SCHEDULE
Date: Friday, May 15, 2015
Time: 5:00 p.m. Packet Pick Up
8:00 p.m. 5K Race & Relay Starts
9:30 p.m. Awards Ceremony
FEES
5K Division: $25 by May 5, $30 on/after May 5
Relay Division: $45 per team of 3
RELAY TEAMS
Register your team captain ONLY on the attached
entry form. Please do not send 3 forms. The other
2 team members must register at packet pick up on
Thursday or Friday.
PACKET PICK UP
Packet pick up will be available on Thursday, May 14
from 5-7 PM in the Health and Science Building. You
may also pick up on race day beginning at 5 PM.
SHIRTS & SWAG
Glow in the Dark racing tech shirts, glow sticks, glow
necklaces, glow bracelets, and other various items
will be placed in your race bags available for pick up
during the times listed above.
Race Course Map:
AGE GROUPS
Under 10, 11-14, 15-19, 20-24, 25-29, 30-34, 35-39,
40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74,
75-79, 80-84, 85 and older
Release Form
AWARDS
Overall: 1st place male and 1st place female will be
awarded medals and plaques.
I, the undersigned, am 18 years of age or older and therefore
an adult according to the laws of the State of Ohio. I am a
guest on the Kent State at Ashtabula Campus and am registered to participate in the KSUA PTA Club Ed Taylor Memorial
5K on Saturday April 26, 2014, sponsored by the KSUA PTA
club (hereinafter 5K).
Age Group: 1st-3rd place males and females will be
awarded medals.
Relay Teams: Each member of the 1st-3rd place relay
teams will be awarded medals.
RACE COURSE
This is a 3-lap race on the Kent State Ashtabula
campus. Start line is on the West side of the Health
& Science Building. Finish line is on the North side
of the Bookstore.
The Relay Teams will consist of 3 runners: 1st runner
starts at start line, 2nd runner starts at the 1 mile
mark, 3rd runner will begin at the 2 mile mark.
QUESTIONS
Contact Tiffany Kiphart at 440-964-4294 or via
e-mail at [email protected].
KENT STATE UNIVERSITY
RELEASE AND HOLD HARMLESS AGREEMENT
I acknowledge and agree that my participation in the 5K is
entirely voluntary and of my own free will. I understand and
recognize that each participant is responsible for his/her own
well-being and the well-being of the group of which he/she is
a part. Additionally, each participant recognizes that it is in his/
her best interests, as well as that of the group, to follow the
suggestions, guidelines, and/or rules of the 5K supervisors and/
or coordinators.
I fully understand and appreciate the potential dangers, hazards and/or risks, directly and/or indirectly inherent in participating in 5K, which could also include the serious loss of limb or
life or loss of property. Also, I understand that the consumption
of alcohol and/or use of drugs is strictly prohibited and could
result in my dismissal from further participation in 5K.
I understand that any University personnel or agents also
participating in 5K are not necessarily medically trained to care
for any physical or medical problems that may occur during 5K.
I further understand that the University does not carry medical
or liability insurance for me while I am participating in 5K. By
placing my signature below, I acknowledge to the University
that I have adequate medical and hospitalization insurance for
any injuries that I may incur as a result of participating in 5K.
NOW, THEREFORE, in consideration for being allowed to
participate in this activity, I agree to hold the supervisors of 5K,
Kent State University, it’s Board of Trustees, agents, officers,
and employees, and student volunteers harmless for any and
all direct, indirect, special or consequential damages, which
it may incur or otherwise be held liable for as a result of my
participation in 5K, even if due to the negligence of any of the
above named parties.
I have read the above terms of this Agreement/Release, and I
understand and agree to the terms and conditions stated herein. This Agreement/Release shall be binding upon my heirs,
administrators, executors, and assigns.
Participant Signature
Sign: _____________________________ Date: ___________
Witness Signature
Sign: _____________________________ Date: ___________
Entry Form
Name: _________________________________
Relay Teams: Team Captain name goes here.
Address: _______________________________
City: ___________________________________
State: ________________ Zip: ______________
Phone #: _______________________________
E-Mail: _________________________________
Make non-refundable check payable to:
Kent State Ashtabula
Memo Line: Ed Taylor 5K
FEES:
5K Division: $25 before May 5, $30 on/after May 5
Relay Division: $45 (team of 3)
Mail to:
Kent State Ashtabula, Attn: Tiffany Kiphart,
3300 Lake Road West, Ashtabla, OH 44004
- OR - Register Online at
www.ashtabula.kent.edu/payhere
Race Option: _____ 5K
_____ Relay Team
Check One: _____ Male
_____ Female
Age (on 5/15/15): _______________
S
M
L
Ed was a PTA in the Ashtabula area who
embodied all that a PTA should: compassion, a
teaching spirit, kindness, empathy, and a caring
spirit. Ed provided many Kent State Ashtabula
PTA students with an education that exceeded
the expectations of a clinical instructor. Ed fought
hard against pancreatic cancer and succumbed to
its effects just one month prior to our first 5K in his
honor in 2008. Ed was a warrior in life and against
his battle with this terrible disease. All proceeds
for this event go directly to The Pancreatic Cancer
Action Network (PAN-CAN) in the memory of our
cancer warrior, Ed Taylor, PTA.
MEMORIAL LIGHTED
PAPER LANTERN RELEASE
At the conclusion of the race and awards we will
be releasing lighted paper lanterns in memory of
or support of all who affected by pancreatic cancer. These lanterns will be available for purchase
at packet pick up and on the night of the race.
GRAND PRIZE RAFFLE
Amout Enclosed $ ___________________
T-Shirt Size (adult):
The Ed Taylor Memorial
5K Run & Relay
XL
XXL
*****
Release Form on opposite side
must be signed in order for
your entry to be accepted.
We will be giving away ONE large gift containing
an assortment of gift cards and products. You will
receive one free entry with your race entry. You
may also purchase additional chances at winning
this prize (all proceeds benefit PAN-CAN).
Seventh Annual
ED TAYLOR
MEMORIAL
5K Charity Race/Relay
Friday, May 15, 2015
8:00 P.M.
Kent State University at Ashtabula
3300 Lake Road West
Ashtabula, OH 44004
Hosted by:
Kent State Ashtabula
Physical Therapist Assistant Program
Student Club