Registration:

• Pre-registration is strongly recommended. Please use the application form by clicking on "printable application" above.
• Entry fee: 5k - $20 post marked by May 7, 2009 --- $25 May 7 to Race Day. 1Mile - $10 before May 7, $15 May 7 - May 9 Please do not register by mail during race week
• Race Day registration: Historic Smithville Park, Eastampton, NJ
• Mail registration and checks: H. B. Smith Industrial Village Conservatory C/O Division of Cultural Affairs & Tourism Po box 6000 Eastampton, NJ 08060
• Online Registration: www.Active.com

Race Highlights

• Starting Time 8:00 - 8:40 am check-in, packet pickup and race day registration; 8:45 am pre-race briefing; 9:00 am 5k race starts, 9:15 1 mile race starts
• Refreshments provided at the end of the race.

• Free Gift: for first 100 registrants.
• Prizes to top three overall male and female winners.
• 5K Awards to top three male and female finishers in the following age groups:
  • 18-24, 25-39, 40-54 and 55 plus
• 1 Mile Fun Run-Walk to top three overall male and female finishers
  • Top 3 male and female finishers in the following age groups:
  • 8-12, 13-17, 18-24, 25-39, 40 plus

For More Information

Email cisellers@verizon.net

Note: No entry fee or portion of entry fee will be refunded, transferred or credited!

Course

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First Name ___________________________ Last Name _______________________

Age ______ Sex ______

Address ________________________________

City ______________________________ State _______ Zip Code __________

Phone _____________________ Email ________________________________

Please check one of the following:

___ 5K ___ 1 Mile

IN CONSIDERATION FOR ACCEPTING THIS ENTRY, AND THE GRANTING OF THE RIGHT TO PARTICIPATE IN THIS EVENT, I, THE UNDERSIGNED, INTENDING TO BE LEGALLY BOUND, HEREBY FOR MYSELF, MY HEIRS, PERSONAL REPRESENTATIVES, SUCCESSORS, AND ASSIGNS, WAIVE AND RELEASE ANY AND ALL CLAIMS FOR LOSSES AND DAMAGES I MAY HAVE AGAINST, BREWERS TOWNE TAVERN, DOCKHOPPERS, COMMISSIONERS OF HADDON TWP., HADDON TWP., WESTMONT, THE POLICE DEPT. OF HADDON TWP., EVENT COMMITTEE, VOLUNTEERS, DQ EVENTS, THEIR REPRESENTATIVES, SUCCESSORS, AND ASSIGNS AND/OR ANY OTHER PERSON WHOMSOEVER FOR ANY AND ALL INJURIES, ILLNESS, INCLUDING DEATH, THAT MAY RESULT FROM MY PARTICIPATION IN SAID EVENT. I REPRESENT AND AFFIRM THAT I AM IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN THIS EVENT, AND VERIFIED BY A LICENSED PHYSICIAN, AND HAVE SUFFICIENTLY TRAINED FOR THE COMPLETION OF THIS EVENT.

THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNED THIS RELEASE & WAIVER

X____________________________________ Date ________________

Make checks payable to: H.B.S.I.V.C.
Mail Checks to:
           H. B. Smith Industrial Village Conservatory
           C/o Division of Cultural Affairs & Tourism
           PO Box 6000
           Eastampton, NJ 08060