The start and finish line of the race is at the Yeunkyung Woo Memorial Garden behind Lilly Hall of Life Sciences.
Name:
Street:
City: State: Zip:
Phone:
Email:
Entry Fees: $10 Adults; $5 Students and children. Please make checks payable to Purdue Foundation.
Completed entry forms
and entry fees will be accepted on the morning of the race. If you want to make a donation to the Achieve
Excellence Travel Scholarships and not participate in the run/walk, please make
your check payable to the Purdue Foundation and mail it to: Development Office,
Department of Biological Sciences,
RACE PARTICIPATION AGREEMENT: In consideration of the foregoing, I, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against any of the sponsors, organizers, Purdue University for any and all claims of damages, demands or loss actions whatsoever which may arise as a result of my participation in this event. I understand and acknowledge that participating in this run/walk event may expose me to dangers from both known and anticipated risks. I attest and verify that I am physically fit and have sufficiently trained for the completion of this event and my physical condition has been verified by a licensed medical doctor. Further, I grant full permission to any and all of the foregoing to use my likeness for any legitimate purpose whatsoever.
Signature
Date
Parent’s or Guardian’s
Signature if under the age of 18:
Date
Return Entry Form and Fee to 1-118,
LILLY, Biology Main Office or 1-120, LILLY, Graduate Office
For Office
Use Only
___Cash ____Check Amount Paid by:
Address: