WHEN: Saturday, April 2nd, 2011 9a.m. Note: Race day registration begins at
7:30 a.m.
WHERE: Simon Kenton High, 11132 Madison Pike, Independence, KY
REGISTRATION: Pre-registration...$10.00(no T-Shirt).....$20.00(with T-Shirt) (add $2 for XXL)
All New Logo with ongoing theme.
Mail-in entries must be received by March 20th, 2011
Race Day Registration...$15.00(no T-Shirt)....$25(with T-Shirt)(add $2 for XXL)
(Race Packets will be picked up the morning of the race, arrive early)
Race Divisions: 14 & under; 15-19; 20-24; 25-29; 30-34; 35-39; 40-44; 45-49; 50-54; 55-59;
60-69; 70 & over
Fitness Walkers: 29 & under; 30-39; 40-49; 50-59; 60 & over.
The Course: 5K(3.1 miles): Local Streets, starting at Simon Kenton High School.
Directions: From Ohio: I-75 south to I-275 east to Exit 80 south (KY17), go 7.8 miles to Simon Kenton High on your right.
OR I-471 to I-275 west to Exit 80 south (KY17), go 7.8 miles to Simon Kenton High on your right. From Kentucky: I-75 to I-275 east
to Exit 80 south (KY17), go 7.8 miles to Simon Kenton High on your right. See MAPQUEST.COM for: 11246 Madison Pike, Independence,
KY 41015.
7:30 a.m.
WHERE: Simon Kenton High, 11132 Madison Pike, Independence, KY
REGISTRATION: Pre-registration...$10.00(no T-Shirt).....$20.00(with T-Shirt) (add $2 for XXL)
All New Logo with ongoing theme.
Mail-in entries must be received by March 20th, 2011
Race Day Registration...$15.00(no T-Shirt)....$25(with T-Shirt)(add $2 for XXL)
(Race Packets will be picked up the morning of the race, arrive early)
Race Divisions: 14 & under; 15-19; 20-24; 25-29; 30-34; 35-39; 40-44; 45-49; 50-54; 55-59;
60-69; 70 & over
Fitness Walkers: 29 & under; 30-39; 40-49; 50-59; 60 & over.
The Course: 5K(3.1 miles): Local Streets, starting at Simon Kenton High School.
Directions: From Ohio: I-75 south to I-275 east to Exit 80 south (KY17), go 7.8 miles to Simon Kenton High on your right.
OR I-471 to I-275 west to Exit 80 south (KY17), go 7.8 miles to Simon Kenton High on your right. From Kentucky: I-75 to I-275 east
to Exit 80 south (KY17), go 7.8 miles to Simon Kenton High on your right. See MAPQUEST.COM for: 11246 Madison Pike, Independence,
KY 41015.
(mail in registration due by March 20th, 2011: Make checks payable to F.O.P. Lodge 75)
Mail To: Independence F.O.P. 5409 Madison Pike, Independence, KY 41051
www.5kfootpursuitrun.com
First Name .Last Name: .
Address:
City: .State: .Zip: .Phone: .
Age as of 4/02/11: . Male: . Female: . Shirt: S M L XL XXL
Race Division:(Circle One) Runner Walker Age Division:
If you were referred by an F.O.P. member, who was it? .
MUST BE SIGNED TO CONSTITUTE VALID ENTRY
In consideration of the acceptance of my entry, I for myself, my executors, administrators & assignees, do hereby
release & discharge all claims against the City of Independence, and any race official, of damages, demands,
actions whatsoever in any manner arising out of my participation in said athletic event. I attest that I am physically
fit and sufficiently trained and have full knowledge of the risk involved. I also agree that I may be examined during
the race by qualified personnel in the event that medical problems arise. The race officials or qualified personnel
have the right to disqualify and remove me from the event if, in their opinion, I may be suffering from a
life-threatening condition. I give permission to use photographs for promotional purposes.
Signature (Parent/Guardian if under 18) ________________________________________________
NOTIFY IN CASE OF EMERGENCY__________________________PHONE____________________
Mail To: Independence F.O.P. 5409 Madison Pike, Independence, KY 41051
www.5kfootpursuitrun.com
First Name .Last Name: .
Address:
City: .State: .Zip: .Phone: .
Age as of 4/02/11: . Male: . Female: . Shirt: S M L XL XXL
Race Division:(Circle One) Runner Walker Age Division:
If you were referred by an F.O.P. member, who was it? .
MUST BE SIGNED TO CONSTITUTE VALID ENTRY
In consideration of the acceptance of my entry, I for myself, my executors, administrators & assignees, do hereby
release & discharge all claims against the City of Independence, and any race official, of damages, demands,
actions whatsoever in any manner arising out of my participation in said athletic event. I attest that I am physically
fit and sufficiently trained and have full knowledge of the risk involved. I also agree that I may be examined during
the race by qualified personnel in the event that medical problems arise. The race officials or qualified personnel
have the right to disqualify and remove me from the event if, in their opinion, I may be suffering from a
life-threatening condition. I give permission to use photographs for promotional purposes.
Signature (Parent/Guardian if under 18) ________________________________________________
NOTIFY IN CASE OF EMERGENCY__________________________PHONE____________________
| 6th Annual Independence F.O.P. Lodge #75 5K Foot Pursuit Run/Walk |
