21st Annual 
Edmund Ganem Memorial 
5K RUN/WALK
Sunday, May 1, 2016
Sponsored by the ROTARY CLUB OF TERRYVILLE

Schedule of Activities:
8:00 – Registration
9:00 – 5K Race/Walk
9:30 – Loop the Lake- 1 mile & Kids Fun Run (5 and under)

FEES:  Run/Walk:  $15.00 (pre-registration and payment must be received by Apr 22)
 $20.00 on race day 
Kids Fun Run –Free 
 Loop the Lake  -$5.00
Please make checks payable to:  “ROTARY CLUB OF TERRYVILLE”, P.O. Box 422, Terryville ,CT  06786  

RACE LOCATION:  Lake Winfield  -  Intersection of Harwinton Ave, Bemis and Holt St -  Terryville, CT

Race features:  Free tee shirts to first 75 applicants (road race runners/ walkers only), electronic timing, 
Music, water stops, refreshments
         Awards:   Male/Female top runners $50 cash prize, awards to all first place finishers in age groups
						  
                                                                       See course map on back
				             
Questions –  HYPERLINK "mailto:rotary5kct@yahoo.com" \t "_blank" rotary5kct@yahoo.com / (860) 585-4031
www.terryvillerotary5k.org
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Kids Fun Run  _____ 	Loop the Lake _____	5K Road Race _____	5K Walk _____

PRINT NAME  ________________________________________________________________________________________________

ADDRESS       ________________________________________________________________________________________________

CITY  __________________________________   STATE _______  ZIP ___________  PHONE _______________________________

EMAIL ADDRESS_____________________________________________________________________________________________

MALE _____  FEMALE ____  SHIRT SIZE:  Small___Medium ___  Large ___  X-Large ___  AGE ON DAY OF RACE _____

I ATTEST THAT I HAVE FULL KNOWLEDGE OF THE RISKS INVOLVED IN THIS EVENT AND THAT I AM PHYSICALLY FIT AND SUFFICIENTLY TRAINED TO PARTICIPATE IN THIS EVENT.  IN CONSIDERATION OF ACCEPTANCE OF MY ENTRY, I, MY EXECUTORS, ADMINISTRATORS AND ASSIGNEES DO HEREBY RELEASE AND DISCHARGE THE ROTARY CLUB OF TERRYVILLE AND ANY OF THE EVENT’S OTHER SPONSORS, THEIR EMPLOYEES, AND ALL OFFICIALS FOR ALL CLAIMS ARISING FROM OR GROWING OUT OF THIS ATHLETIC EVENT.

SIGNATURE OF RUNNER (or parent if runner is under 18): ____________________________________________________  DATE: ________/________/