B5K:Sign-up Form

B5K

To Benefit Pancreatic Cancer
June 22, 2008



2nd ANNUAL B5K & BLOCK PARTY
5K Road Race & Fun Walk
Sunday, June 22, 2008 • 11:00 am
BLOCK FIVE BISTRO 139 Green St. • Worcester, MA

Proceeds from the event will benefit The Pancreatic Cancer Alliance.
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Registration:
10:00 am
Start Time: 11:00 am

Entry Fee: $30 (additional donations from sponsorship)
Includes T-shirt & Refreshments.

Amenities: H20 stations, entertainment, raffles, children activities, food, beer, wine & soda.

Checks Payable to:
Block Five / B5K

For more information:
email: b5k@block5bistro.com
or contact Mike Covino @ 508.767.3483
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Please enter me in the 2nd Annual B5K. I agree to assume all responsibility for all risk of damage or injury to me as a participant in this event. In considerationof being accepted as an entrant, I herby, for myself, my heirs, executors and administrators, release and discharge Block Five Bistro and all other individuals, entities and organizations associated with the race from all claims, damages, rights of my action, present or future, whether the same be known, anticipated or unanticipated, resulting from or arising out of or in incident to my participation in this event. I hereby certify that I will not participate in the B5K unless I am physically fit and sufficiently trained for the competition in the race. I also grant permission for the use of my name and of picture in any broadcast, photograph or other account of this race. I understand that (except for the walk) bicycles, skateboards, baby joggers, strollers, roller skates, or blases, animals and radio headsets are not allowed in the race and I abide by this guideline.


First Name*
Last Name*
E-mail*
Age On Day Of Race*
City*
State*
Zip*
Phone*
Sex* M F
T-shirt Size*

M L XL


$30 (base registration fee)


Visa MC AMEX Discover
Card Number - - -
Expiration /

PLEASE BRING ANY ADDITIONAL FUNDS THROUGH SPONSORS TO THE DAY OF RACE!


* By submitting this form you agree to all of the terms and conditions listed above.


Download Sign-Up Sheet (PDF)
Download Sponsor Sheet (PDF)


Niche Hospitality Group •
nichehospitality.com