AHS Student Council 5k Fun Run/Walk/Roll-a-thon
Registration Form
Saturday, April 21st, 2007 @ 11 : 00 am
Event Information:
The 5k Run/Walk/Roll-a-thon will take place behind the PEB building (901 W. Roosevelt Chicago, IL 60607) on the South Field. Pre-registration for this event will begin at 9:30 am on Saturday, April 21st. All preregistered participants must show up to the preregistration prior to 10:45 am. All walk-in registration will be available from 9:30 am-10:45 am. All registration ends at 10:45 am on Saturday, April 21st. At the pre-registration, race participants will receive their number, a t-shirt (if they are one of the first 100 participants), and sign a participation waiver. Food and beverages will be available during the entire event!!! Prizes will be awarded to the first, second, and third place winners of our race. Other raffle prizes will be given away at the end of our event. Meter parking is available in the area. There is a UIC parking lot across the street on Roosevelt and Morgan. AHS Student Council will be providing accommodations for people with disabilities. If you have questions about these accommodations or would like to request accommodations, please email us at: ahs.council@gmail.com. Accommodations that we will be offering are a paved track and ramps enter and exiting the course.
There are 3 ways in which you can register for the 5k Fun Run/Walk/Roll-a-thon:
1 . Drop off this registration form to :
Eileen Doran Room 560 at AHS Building
(1919 W. Taylor) (901 W.
OR
Randy Stone Room 337 at the PEB Building
Roosevelt)
EXACT CHANGE must be with the form. Please place the registration form and $5.00 fee and envelope. One entry per envelope please!!
2. Mail this form to:
Attn: AHS STUDENT COUNCIL Katie Stefani Room 337 PEB 901 W. Roosevelt Chicago, IL 60607 Please Note: If registration is mailed the $5.00 fee must be sent in a money order. This is to
ensure your money arrives in our hands safely and easily.
3. Register during the pre-registration for all 5k participants. The fee will cost $8.00 the day of the event. CASH ONLY!!
Questions? email ahs.council@gmail.com
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The first 100 participants will receive a T-shirt. Gift certificates and other prizes will be awarded to participants the day of the race.
All UIC students and faculty are encouraged to participate, especially those within the College of Applied Health Sciences. Please note: This registration is for participants only. If you cannot participate but would like to volunteer please email:
ahs.council@uic.edu
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**ALL PARTS OF THIS FORM MUST BE COMPLETED TO BE PROPERLY REGISTERED FOR THIS EVENT. Any incomplete forms will not qualify you as a participant in this event and no refunds will be submitted!!!
Date: ___________ (no rollerblades please) Check ONE OPTION: I will Run or Walk the 5k I require a wheelchair and will Roll the 5k
Name:
________________________________________
(last name) (first name)
Date of Birth: ___________
Address:
_____________________________
_____________
city, state
_____________
zip code
*email address: ______________________________
Major/Department: ________________________
I have completed all parts of this form and attached my $5.00 registration fee in an envelope. I understand the conditions of this event and will be in attendance for the pre-registration!! (9:30am-10:45am on 4/21 behind PEB. Entrance to the event and more info to come)
______________________________________
signature
_____________
date
