Shirt Size: YM YL S M L XL 2XL. Event: ______ 5K RACE ______ 5K Walk ln consideration of your accepting this entry, l, t
Dr. Greg DeSimone Memorial 5K Run and Walk In support of a Scholarship Fund for Physician Assistant Students
Paradocx Vineyard ~ Landenberg, PA The Race Through the Grapes is a challenging cross country 5K through the grounds of Paradocx
Vineyard. Rolling hills, wooded areas and dirt trails will weave participants through the vineyard making this a beautiful and scenic event at the height of fall. Enjoy a complimentary wine tasting in a souvenir wine glass following run/walk as participants gather to await race results! Greg DeSimone, M.D, was the longtime medical director of the Emergency Department at Jennersville Regional Hospital. During his 22-year tenure, he saved countless lives and cared for many living in our community. In addition to his expertise in emergency medicine, he was known for his smile, his kindness and, most of all, his willingness to listen carefully to all who sought his care.
EVENT DETAILS Time: 11 a.m. start for 5K with walk shortly after. Packet pick-up/day of registration: 9:30 to 10:45 a.m. Awards: Top male and female finishers receive gift certificates. Top three finishers in age categories receive medals. Race results handled by Chester County Running Store. Entry Fee: T-shirts to all who register by 9/15/14. Online registration: www.sccems/content/race Adults over the age of 21 $40 After 9/15/14: $45 Youth and Young Adults under 21 $30 After 9/15/14: $35 To register by mail, send form with a check payable to: SCCEMS - RACE Registration, PO Box 8012, West Grove, PA 19390 First Name:____________________________ Last Name:________________________________________ Date of Birth:__________________________ Age on race day:___________________________________ Phone number :________________________ E-mail address:____________________________________ Address:_________________________________________________________________________________ City:_________________________________________ State:____________ Zip code:_________________ Shirt Size: YM YL S M L XL 2XL Event: _______ 5K RACE ________ 5K Walk ln consideration of your accepting this entry, l, the below signed, intending to be legally bound, for myself, my heirs, my executors and administrators, waive and release and any all rights and claims for damages, may have against the race, and sponsors and their representatives, successors and assigns for any and all injuries suffered by me in said event. I attest that I will participate in this event as a footrace, that I am physically fit and sufficiently trained for the completion of this event. Furthermore, I hereby grant full permission to use my name and likeliness, as well as any photographs and any record of this event in which I may appear for any legitimate purpose, including advertising and promotion.
Signature:______________________________________________________ Date_______________ Parent or Guardian if under 18:_________________________________________________________
