Registration

WHEN: Saturday, September 8th, 2007    9a.m. Note: Race day registration begins at
      7:30 a.m.
WHERE: Simon Kenton High, 11132 Madison Pike, Independence, KY
REGISTRATION: Pre-registration...$10.00(no T-Shirt).....$20.00(with T-Shirt)
                        All New Logo with ongoing theme.
                        Mail-in entries must be received by September 2nd, 2007
                        Race Day Registration...$15.00(no T-Shirt)....$25(with T-Shirt)
                        (Race Packets will be picked up the morning of the race, arrive early)
Race Divisions: 14 & under; 15-19; 20-24; 25-29; 30-34; 35-39; 40-44; 45-49; 50-54; 55-59;
                   60-69; 70 & over
Fitness Walkers: 29 & under; 30-39; 40-49; 50-59; 60 & over.
The Course: 5K(3.1 miles): Local Streets, starting at Simon Kenton High School.

Directions: From Ohio: I-75 south to I-275 east to Exit 80 south (KY17), follow until it dead
ends, take a right and continue south on KY 17 until you come to school on right (just past Krogers).
OR I-471 to I-275 west to Exit 80 south (KY17), follow until it dead ends, take a right and continue
south on KY 17 until you come to school on left. From Kentucky: I-75 to I-275 east to Exit 80
south (KY17), follow until it dead ends, take a right and continue south on KY 17 until you come to
school on right (just past Krogers). See MAPQUEST.COM for: 11246 Madison Pike, Independence,
KY 41015.

(mail in registration due by August 25th: Make checks payable to F.O.P. Lodge 75)
Mail To: Independence F.O.P. Lodge 75, P.O. Box 815, Independence, KY 41051
                                   www.5kfootpursuitrun.com
First Name                                   .Last Name:                                                                                  .

Address:

City:                                     .State:              .Zip:               .Phone:                                                  .

Age as of 9/8/07:                  .Sex:                 .Male:            .Female:             .Shirt:    S   M   L    XL

Race Division:(Circle One)     Runner             Walker                 Age Division:                                   .

                                          MUST BE SIGNED TO CONSTITUTE VALID ENTRY
In consideration of the acceptance of my entry, I for myself, my executors, administrators & assignees, do hereby
release & discharge all claims against the City of Independence, and any race official, of damages, demands,
actions whatsoever in any manner arising out of my participation in said athletic event. I attest that I am physically
fit and sufficiently trained and have full knowledge of the risk involved. I also agree that I may be examined during
the race by qualified personnel in the event that medical problems arise. The race officials or qualified personnel
have the right to disqualify and remove me from the event if, in their opinion, I may be suffering from a
life-threatening condition. I give permission to use photographs for promotional purposes.

Signature (Parent/Guardian if under 18) _______________________________________

NOTIFY IN CASE OF EMERGENCY__________________________PHONE____________________