19th Annual Old National Turkey Day Runaway Getaway
Official Entry Form

Event Entering (must check one box): 
c 5K Run     c 5K Racewalk     c   5K Walk      c   Phantom Runner     c  Wheelchair Participant
                       (This is not a sanctioned walk)

Gender (must check one):     c Male     c Female          Age (required):  _____________

T-shirt Size: 
 c Youth Medium    c Adult Small    c Adult Medium    c Adult  Large  c  Adult  X Large c  Adult  2X Large
           

Name (please print):  _____________________________________________________________________

Address:  _____________________________________________________________________________

City, State, Zip Code:  ___________________________________________________________________

Telephone:  (       )_______________________________       Fax Number: (       )_____________________    

E-Mail Address:  _______________________________________________________________________

Amount Enclosed (must check one):
Ages 17 & under                                                                 Ages 18 & up
c $20 if entry & full payment received before 11/21/08       c $25 if entry & full payment received before 11/21/08
c $25 if entry & full payment received after 11/21/08          c $30 if entry & full payment received after 11/21/08

Method of Payment (must check one):
c Check, payable to Evansville Goodwill Industries, Inc. 
c  Visa                     c  MasterCard                        c Discover

  Credit Card #:  _______________________________      Exp. Date:  ______________________

  Signature (if paying by credit card):  _________________________________________________

WAIVER

In consideration of the acceptance of my entry, I for myself, any executors, administrators and assignees,
do hereby release and discharge all sponsors, the Goodwill Family Center, Evansville Goodwill Industries, Inc.,
the Greater Evansville Runners and Walkers Club, the State of Indiana, Vanderburgh County, the City of Evansville,
Race Officials and all employees, officers, and volunteers of the aforementioned organizations for all claims of damages, demands, and/or actions whatsoever in any manner arising or growing out of my participation in said event.  I attest and verify that I am physically fit and sufficiently trained to participate in this event.

_____________________________________________          ____________________________
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: 
19th Annual Old National Turkey Day Runaway Getaway
500 S. Green River Rd.
Evansville, IN  47715

Or fax the form to Judi Early at 812-474-2233.