Philadelphia University RAM RUN ENTRY FORM Saturday/March 26, 2011
Please Print Clearly (Check if Applicable)
I am a Philadelphia University: STUDENT_______ FACULTY/STAFF__________ ALUMNI__________
I am a resident of Roxborough (19128 zip code)_________ (choose only 1 category if applicable)
* 5k is a Competitive Running race and also open to fitness walkers
Entry Fee: 5k RUN $ 20 (up to and including 3/19/11) $25 (after 3/19/10)
$15 for all Students or less at all times (College age of 22 yrs old or less)
List School Name if you are a student:____________________________________________
Name__________________________________________ Sex________ AGE on Race Day__________
Address________________________________________________________ City____________________
State__________ Zip_______________ T Shirt Size (S-M-L-XC)______________
E Mail___________________________________________________
TEAM NAME (Team Name Must be Exactly Similar to your teammates entry form)
Team Name____________________________________________________________ (open to student, corporate, or club teams).
Teams must be made up of either ALL MALE or ALL FEMALE runners. Unlimited number of runners allowed for each team with top 3
runners scoring for the team)
Checks Made Out to : Philadelphia Athletic Charities
Send Check and Entry to :
Philadelphia Athletic Charities
611 Jamestown Street
Philadelphia, Pa 19128
Waiver/Release:In Consideration of accepting this entry, I the undersigned, assume the responsibility for any injury or accident which
may occur during the event or while I am on the premises of the event. I hereby release and hold harmless Philadelphia Athletic Charities,
Philadelphia University, The City of Philadelphia, and any sponsors, volunteers, or race personnel associated with the event, whether injury
occurred by negligence on the part of the sponsors or race persons. I verify that I am physically fit and have been examined by a licensed
MD. I hereby grant full permission to use any likeness from this event in the promotion of the event.
SIGNATURE (Or Parent if Under 18 years old)_______________________________________________ Date_______________
