Clinic Classic
Community Medical Clinic of
110-C
(803) 713-0806 ph / (803) 713-0526 fax /
www.cmcofkc.org
THIRD ANNUAL CLINIC CLASSIC 5K WALK/RUN
& 10K RUN
Saturday April 24, 2010
To benefit the COMMUNITY MEDICAL CLINIC of
Lead Partner McDONALDS
USATF certified course, Awards to top male and female runner and age groups
Refreshments will be available for all participants
Location Community
Medical Clinic 110-C
(behind the United Way) Run begins & ends at the Clinic
Fees 5K Walk/Run $25___ 10K Run $30___Late registration after April 1.
Add $5 for late registration. Run will proceed rain or shine.
Registration Mail completed registration form and check or money order payable to the
Community Medical Clinic, to Strictly Running,
Schedule 7:30 am Packet pick-up and late registration
8:30 am 5K Walk/Run &10K Run
For further information please contact the Clinic at (803) 713-0806 or www.cmcofkc.org
________________________________________________________________________
THIRD
ANNUAL CLINIC CLASSIC 5K Run/Walk
& 10 K Run
Event ______5K Walk _______5K Run _______10K Run _______________Age
Name________________________________________Male_______Female__________
Address________________________________City______________________________
State__________________________________Zip_______________________________
Phone________________________Emergency Contact___________________________
T-Shirt Size S______M______L_______XL_______XXL_______Youth YM_________
Waiver: I, the undersigned applicant, for and in
consideration of the benefits derived by participation in the Community Medical
Clinic program, do hereby release and forever discharge the Community Medical
Clinic, it’s agents, staff, sponsors and representatives from and against any
and all liability and responsibility for any injury, illness or sickness which
may result from participation in the Community Medical Clinic program or
general recreation and do hereby further agree to indemnify and hold harmless
the Community Medical Clinic, it’s agents, sponsors and employees.
_____________ _________________________________________________________
Date Signature of participant or guardian if under 18