25th Annual Turkey Day 5K
November 27, 2014 - 8 a.m.

Official Entry Form

Event Entering (must check one box): 

Are you a challenged athlete?

Gender (must check one):       Age (required):               Date of Birth (required):
                             Month:     Day:    Year:       

T-Shirt Size
(We cannot guarantee t-shirt for entries received after 11/14/2014.  Sizes available first come, first served. If you do not wish to receive a t-shirt, please select "NO SHIRT." You will behelping us keep costs down and help make more funds available for the mission of Goodwill Industries.)

In Case of Emergency (Emergency contact cannot be an event participant.)
Contact Name:
Contact Telephone Number:

Amount Enclosed (must check one):
Ages 18 & up        Ages 17 & under
 $25 if entry & full payment received before 11/21/14    before 11/21/14
$30 if entry & full payment received after 11/21/14     $25 if entry & full payment received after 11/21/14

Method of Payment (must check one): (Make checks and money orders payable to Evansville Goodwill Industries, Inc.)

Debit/Credit Card #:        Exp. Date       CVV Code:

Signature (if paying by debit or credit card): 

                                                                          WAIVER
I know that running or walking a road race is a potentially hazardous activity.  I should not participate unless I am medically able and properly trained. I also know that, although police protection will be provided, there will be traffic on the course route.  I assume the risk of running into traffic.  I also assume any and all other risks associated with running this event including but not limited to falls, contact with other participants, the effects of the weather and the condition of the roads, all such risks being known and appreciated by me. Knowing these facts, and in consideration of your accepting my entry, I hereby for myself, my heirs, executors, administrators or anyone else who might claim in my behalf, covenant not to sue, and waive, release and discharge Evansville Goodwill Industries, Inc., the Goodwill Family Center, all sponsors, the State of Indiana, City of Evansville, Vanderburgh County and Race Officials and volunteers, any and all claims of liability for death, personal injury or property damage of any kind or nature whatsoever arising out of, or in the course of my participation in this event.  This Release and Waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown.  The undersigned further grants full permission to Evansville Goodwill Industries, Inc. all sponsors and/or agents authorized by them, to use any photographs, videotapes, motion pictures, recordings or any other record of this event for any purpose.  Application for minors will be accepted only with parent's signature.  NOTE:  This event will occur rain or shine.  We reserve the right to cancel in extreme circumstances. In that event, there will be no refunds; rather, your entry fee will be used as a donation to the Goodwill Family Center.

         
Signature of Participant                                                                                                       Date

         
Signature of Parent/Guardian                                                                                              Date

PARENT OR GUARDIAN MUST SIGN IF APPLICANT IS UNDER 18 YEARS OF AGE.  INCOMPLETE OR UNSIGNED ENTRIES WILL RESULT IN THE ENTRY BEING INVALID.

Please send or bring this completed form with appropriate registration fee to: 
25th Annual Old National Turkey Day 5K
500 S. Green River Rd.
Evansville, IN  47715

Or fax the form to Amanda Simmons at 812-474-2233.