6th Annual
ALEX BARAJAS FOUNDATION
5K Run / Walk
Saturday, January 21, 2017
Lake Placid Christian School

148 E. Interlake Blvd., Lake Placid, FL 33852

Racers take their marks at 8:00 a.m. for the 5K Run/ Walk! Day of race registration will begin at 7:00am.  All proceeds benefit the Alex Barajas Foundation. We will have a silent auction and raffle!

RACE LOCATION: Lake Placid Christian School
ENTRY:  5K race with t-shirt $25 or $10 with no shirt.  Deadline for registration is 1/12/17.  Late registrants pay $30 and are not guaranteed a shirt. 
AWARDS: Award ceremony following run/walk.  Overall winners in each gender group and masters will receive an award. Top three in each age/gender group will receive medals.
CONTACT:  For additional information and/or questions, email elviabarajas24@icloud.com.

                                       Please fill out and detach one entry form per runner walker.

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2016 ALEX BARAJAS FOUNDATION 5K Run / Walk Registration

Choose your event!__5K Run___5k Walk
Last Name:  		 First Name:  	 Gender: Male  	Female__
Address:_________________________________City:______________State:__
Zip:_______ Phone:______________Email:_____________________________
Date of Birth (M/D/Y):  	/ 	/ 	Age as of 1/21/17:  	

Waiver: In consideration of this entry, being accepted, I hereby for myself, heirs, executers and administrators waive and release any claims that I may have against the Alex Barajas Foundation or any of the sponsors involved in the 5K event.  I certify that I am or those I am registering are physically able to participate in the event.
           Signature:  	 ________________Date: ______
                                                                                      T-shirt Size: ______    $25 Registration….. $_____
                                                                                      $10 Registration with NO SHIRT $_____
							
You may purchase additional race t-shirts for $15 each.
They are available in the following sizes: Adult S, M, L, XL, XXL and Children’s S, M, L. Please list additional number of t-shirts and sizes below.

Please order me____ extra shirts in the size(s):  ________@ $15 each…..$______ Total Enclosed $_____

Please return registration and payment by Jan. 12, 2017.
You may drop them off at the Blueberry Patch or mail to: Alex Barajas Foundation, 1008 Burnett Street, Lake Placid, FL 33852
Make checks payable to Alex Barajas Foundation.
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