3rd Annual High Springs 5K Spirit Run May 22, 2004 at 6 PM Civic Center Park in High Springs, FL (Registration: 4:30-5:15 PM) Proceeds will benefit athletic programs at High Springs schools.

5K Entry Fees	Early Registration	Day of Race
FTC members:	$15.00	$20.00
All Others:	$17.00	$20.00
No T-shirt option:	$10.00	$12.00
17 years and younger:	FREE	FREE

For more information, call Jerry Bracher at (386) 454-1416 ext. 228 or the Florida Track Club at (352) 378-8725.

Please make checks payable to City of High Springs and mail to:
City of High Springs
110 NW 1st Avenue
High Springs, FL 32643

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Last Name_____________________ First Name ___________________ Male___ Female ___
Date of Birth (MM/DD/YY) ____________ Age (race day) ____
T-shirt size: S M L XL None
Healthy Heart Walk? _____ Florida Track Club Member? ____

Street Address ______________________________________________

City ____________________________ State ______ Zip Code _______
Evening Phone ___________________ Day Phone _________________
E-mail _____________________

High Springs 5K - Amount Enclosed __________ Check __ Cash __

I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running in this event including, but not limited to: falls, contact with other participants, the effect of the weather, including high heat and/or humidity, traffic and conditions of the road, all such risks being known and appreciated by me. I understand that bicycles, skateboards, baby joggers, roller skates or blades, animals and radio headsets are not allowed in the race and I will abide by this guideline. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the ROAD RUNNERS CLUB OF AMERICA, the FLORIDA TRACK CLUB, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event though the liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I further grant permission to this race and organization conducting the race and/or agents authorized by them to use any photographs, videotapes, motion pictures, recordings, or any other record of this event for any purpose.

Signed:____________________________________________ Date:___________
If under 18, signature of legal guardian:_____________________________