5K Wilenchik Walk for Life

March 7, 2009

The 5K Name
Address
City State Zip
Telephone:
E-Mail:
Emergency Contact:

Check here if you are a cancer survivor

To Register:
Obtain Registration Form Online at: www.schertz.com
OR
Proceeds to Pick up or drop off Form(s) with Registration Fee and contributions in
sealed envelope at:
Benefit the Administration Bldg 2 or Municipal Bldg 1
1400 Schertz Parkway
Cancer Therapy & Schertz, Texas 78154
OR
Research Center You may register On-Site on March 7, 2009.

Final Deadline for all Fees and Contributions:

March 7, 2009 at Registration

Pre Registration Fee Registration Fee

By February 20, 2009 After February 20, 2009
Saturday 18 and up $15.00 18 and up $20.00
March 7, 2009 13-17 $5.00 13-17 $10.00
12 and under FREE 12 and under FREE
Rain or Shine
Registration Registration fee is enclosed. Payable to: City of Schertz-WWL
7:00 a.m. Yes I would like a receipt for tax purposes
Start Walk
All Fees and Contributions are tax deductible
8:30 a.m.
Waiver
On Site Registration and This waiver must be signed by participant or parent/guardian. I understand that my consent
to these provisions is given in consideration of the acceptance of this registration and for
Start at: being permitted to participate in this event. I am a voluntary participant in this event and in
good physical condition. I know that this event is a potential hazardous activity and I
Schertz Library assume full responsibility for all injury or accident, including but not limited to contact
608 Schertz Parkway with other participants, effect of heat, humidity, traffic and the condition of the route. I
release the City of Schertz and sponsors from all claims/liabilities that might occur from my
Schertz, Texas 78154 participation.

_____________________________________________________________
Signature Date