The Teachers Association of Lee County Offers The 2nd annual Dollars for Scholars 5K Run/Walk Saturday, April 25, 2015 at 6:00 p.m. Rotary Park, The Rose Garden, Cape Coral, FL REGISTRATION: ____ Runner Last Name:_____________________ ____ Walker First Name:_______________________ Mailing Street Address: ____________________________________________________ City: ____________________ State:_________ Birthday: _____/_____/__________ Age: ________ Zip Code:_______________ Circle One: Male Female All proceeds benefit the TALC Scholarship Fund oﬀering scholarships to local students of TALC members. E-Mail Address:_______________________________________ T-Shirt Size (Circle One) Adult S M L XL 2XL 3XL Youth S M (Shirt guaranteed for all participants registered by April 18, 2015 _____ Early Pre‐Registered Adult (18 and over) ($20) _____ Early Pre‐registered Lee County Teacher ($15) _____ Early Pre‐Registered Youth (under 18) ($10) _____ A er April 18, 2015, all ages ($25) _____ Cheer from the Couch Dona on ($20) Awards: Registra on also available at Ac ve.com Fee _______________= Total Due$________________ Checks Payable to: TALC (Teachers Associa on of Lee County) Mail Entry with Check to c/o The Run Shoppe, 1407 Cape Coral Pkwy E Cape Coral FL 33904 Male and Female ‐ Top Overall, Masters, Grand Masters, & Senior Grand Masters. Top 3 in each age group. Age divisions: Male and 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+ + SCHOOL PARTICIPATION CHALLENGES Waiver of Liability Release form is mandatory. Incomplete or unsigned entry form cannot be accepted. The race will be run rain or shine, no refunds please. Due to the nature of the course and for the safety of all par cipants, unregistered par cipants, unauthorized vehicles, bicycles, roller blades/skates, skateboards, strollers, headphones and pets are strictly discouraged. If you disregard these restric ons, you are increasing risk of injury to yourself and others and are assuming full responsibility for all injuries. Hot and humid condi ons may exist; drink plenty of fluids before and a er the race. In considera on of the acceptance of this entry, I release from their own negligence, the Teach‐ ers Associa on of Lee County, 3D Racing, The Run Shoppe, race oﬃcials and mers and all individuals any way connected with this event, from any injury or illness I may sustain during my par cipa on in this event or which in any way is associated with this event. I a est that I am physically fit and I have trained suﬃciently for the comple on of this event. I a est that I am informed of the dangers of running in hot and humid weather. _______________________________________________________ __________________________________ Signature of runner/walker or parent/guardian of those under 18 Date