5th Annual The Fast and The Furriest 5K Run/1 Mile Fun Walk Saturday April 18, 2015 Hammond Stadium Race or Walk with or without your furry friend! 8:00AM–All Runners 8:05 All 1 Mile Walkers Early packet pick up at PETCO, 9380 Dynasty Drive, Fort Myers Friday, April 17, 12:00pm-6:00pm or day of race at Hammond Stadium at event registration 6:30-7:30 A.M. AWARDS WILL BE GIVEN TO OVERALL MALE & FEMALE AND TOP 3 IN EACH AGE GROUP (MALE & FEMALE) 10 & Under, 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 & Up and Weight Category of Pets Course will be open for at least 1 hour - results will be tallied as soon as possible Create your own Fundraising Page Pledge to help the homeless pets of the Gulf Coast Humane Society even more by having your run/walk sponsored by friends, family, co-workers and classmates! Sign up and get your own web page, post pictures and messages and raise money for the furry ones in need. Sign up at http://www.active.com/donate/GCHSFL5K2015 Awards will be presented to Top Team and Top Individual Fund Raiser *Pets are welcome to participate with their Guardians but MUST be leashed (non-retractable leads only) and up to date with vaccinations. They must be accustomed to the distance and weather (3.1 miles) and able to not interfere with other participants or pets. T-Shirts to the first 300 Participants to Register - Please Pre-Register Pre-Registration Fees: (Check Box Below) 5K (chipped) Run Adult- $30 5K Run (chipped) Youth 17 and Under- $20 1 Mile Fun Walk/Run- All Ages $15 Family Pack* for 1 Mile Fun Walk/Run- $40 Entry with Dog - Additional $5 (* Family Pack allows 2 Adults, up to 4 Youths - 1 T-shirt only given) *****Day of Race (chipped) $35 Adults and $25 Youth 17 and Under***** Name_ FORM MUST BE COMPLETELY FILLED OUT, SIGNED, DATED FOR REGISTRATION OR REULTS MAY NOT BE COUNTED - PLEASE WRITE LEGIBLY Date of Birth /_ Address City Age State_ Zip Phone Adult T-Shirt Size: (Circle) Male Female XS Will a dog participate with you? (Circle) Weight Category: Total Amount$ Y Small (20 lbs & Under) S N M L XL /_ Gender (circle) M F Email PLEASE NOTE: Shirt sizes are based on availability If Yes, Name Medium (21-50 lbs) Credit Cards Accepted # Large (51 & Up) Exp date Signature at the bottom of this form will constitute approval and commitment to charge amount to our credit card. Visa, MasterCard, AmEx and Discover, accepted. Make checks payable to: The Gulf Coast Humane Society, 2010 Arcadia Street, Ft Myers, FL 33916 239-332-0364 You can Mail, or Fax registration to 239-332-8676 Or register on-line at www.3Dracinginc.com , www.active.com Release and Waiver: In consideration of acceptance to this event, by signing below, I assume all risks and hold harmless the sponsors, officials, volunteers and all persons associated with the Gulf Coast Humane Society, #D Racing, Simon Mall, Coconut Point and the City of Estero, from any liability, claims or causes of action of any kind and nature arising out of or relating to my participation in the event. For the safety of all participants: no unregistered part icipants, bicycles, skateboards, roller skates/blades, or retractable leashes will be permitted. Baby joggers/strollers and head phones are discouraged. Any animals that participate MUST be leashed, vaccinated and physically capable of the event and must not interfere with other participants. Please only bring pets that are accustomed to this distance and possible weather conditions. If you disregard these restrictions, you are assuming liability for any injury which may occur to yourself or others during this activity. Hot and humid conditions will likely exist, drink plenty of fluids prior to the race and replenish at the hydration station along the route and after the finish line. I also give permission for the free use of my name -and pet(s) name(s) if applicable - and picture(s) in broadcast, telecast, web posting, or written account of this event. I further certify that I am properly trained and physically fit, capable of this event and acknowledge the dangers of participation. Signature (Or parent/Guardian in under 18 Date