5K & 10K  Freedom Run 
January 19, 2008, 9:00 a.m.
Morrow, GA

OFFICIAL ENTRY FORM – PLEASE PRINT

First Name: _____________________ Last Name______________________ Birthdate (M/D/Y):__________

Circle One:    M       F            Daytime Phone: (_____)_______________  Email: __________________________ 

Street Address: ___________________________________________________________________________  

City, State, Zip: ______________________________________________________________________

Event (circle one):     No shirt option                5K                    10K                        Family Rate

T-shirt size (circle one):     S        M        L        XL        2XL (add $2)        3XL (add $4)

Cost: tshirts guaranteed to pre-registered runners on race day.
5K/10K: $18 by 1/11/08. Late and race day registration will be $25.
Family Rate of 3 or more: $45 by 1/11/08. Late and race day registration will be $60
No shirt option: $10 by 1/11/08. Late and race day registration will be $15

Waiver: In consideration of the acceptance of this entry, I waive any and all claims for myself and my heirs against Southlake Kiwanis and Clayton College & State University and officials and sponsors of the 2008 5K Freedom Run for injury or illness which may result directly or indirectly from my participation. I also give my permission for the use of my name and/or picture in any media or any other account of this event.

Signature of Participant ________________________________________________ Date _______

Signature of Parent/Guardian ____________________________________________ Date ________
(if participant is under 18)

Please make all checks payable to
Southlake Kiwanis Charities, Inc.

Please return completed registration form to:
Freedom Run
Clayton State Athletics
2000 Clayton State Boulevard
Morrow, Georgia 30260