PRE-REGISTRATION FEES LOCATION

The Race/Walk will be held at Kalamazoo Valley Community College located at 6767 West O Avenue, Kalamazoo, Michigan.

(Registered before April 20, 2012) Spaghetti dinner only Spaghetti dinner 5K Run/Walk 5K Run/Walk only 5K Run/Walk Student Team of 4 (Race only) $10.00 $30.00 $25.00 $20.00 $80.00

EZ

SPAGHETTI DINNER
There is an optional pre-race spaghetti dinner on Friday April 20th starting at 4 p.m. at Kalamazoo Valley Community College. Nikos Landing will be providing a spaghetti dinner for interested runners and families. There is an additional cost for the dinner. What better way to carb up the night before the race!!

SAME DAY REGISTRATION FEES

Spaghetti dinner only Spaghetti dinner 5K Run/Walk 5K Run/Walk only Note: No late team entries

MEMORIAL RUN

(After April 20, 2012 no guarantee of t-shirt) $12.00 $35.00 $30.00

EZ MEMORIAL TEAMS
Register as a team and save. Teams can be made up of friends, co-workers, family. There is no age restriction. All team registrants must fill out a separate registration form and return all four (4) registrations for the team members together, along with the entry fee of $80.00. All entries must be mailed and postmarked on or before April 18th, 2012. After April 20th there are no team registrations.

AGE CATEGORIES
(5K Run/Walk) Men and Womens Divisions Mens Overall Womens Overall Age Brackets 10 and under, 1014, 1519, 2029, 3039, 4049, 5059, 6069 and 70 and over

TIMING & RESULTS

Timing and results will be provided by Great Lakes ChampionChip, Inc. To register online and to get results after the race go to www.greatlakeschampionchip.com.

EZ MEMORIAL RUN T-SHIRTS

Every pre-registered participant in the EZ Memorial Run/Walk will receive a Memorial Run T-Shirt. There are no guarantees for t-shirts after the registration closing date. Adult sizes only.
RECEIVE MORE INFORMATION AT www.ezmemorialrun.com and LIKE US ON Facebook at Eric-Zapata-Memorial-Foundation

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April 21st 2012

at Kalamazoo Valley at Kalamazoo Valley Community College Community College

ENTRY FORM
BACKGROUND/PROCEEDS
On April 18, 2011 we all suffered a great loss when Officer Eric Zapata from Kalamazoo Department Public Safety was killed in the line of duty. He dedicated his life to serving the people of Kalamazoo and preserving the safety of our community. To honor Eric and his legacy, the Greater Kalamazoo Fraternal Order of Police Lodge # 98, has partnered with the EZ Memorial Foundation to establish the 1st annual EZ Memorial Run. Proceeds from this event will be used to establish a scholarship fund for individuals enrolling in Law Enforcement programs at Kalamazoo Valley Community College and Grand Rapids Community College.
Please print all information clearly and sign form. ________________________________________________ Name ________________________________________________ Address ________________________________________________ City ________________________________________________ State Zip (__________) ____________________________________ Phone ________________________________________________ Email ________________________________________________ Emergency Contact ________________________________________________ Contacts Phone ________________________________________________ Team Name

5k Run and Walk $25.00 5k Team Run $80.00

Female

Male

Birthdate: ____ / ____ /____ Age on 04/21/12: _________

T-Shirt Size:

Small X-Large

Medium

Large

XX-Large ($2.00 extra)

I own my own ChampionChip, my number is: ____________ I will use the ChampionChip provided by the race and will return it after the race. I understand there will be a $30.00 fee if I do not return my chip.

SCHEDULE
The 5K Run/Walk will begin at 9:00 am. Check-in & same day registration begins at 7:00 am until 8:30 am at Kalamazoo Valley Community College. Event occurs rain or shine.

PRE-PACKET PICK-UP & PRE-REGISTRATION

Friday from 4:00 pm until 7:00 pm at Kalamazoo Valley Community College inside of Gym A. Signs will be posted directing participants to Gym A.

Mail entries and checks to: EZ Memorial Foundation P.O. Box 19706 Kalamazoo, MI 49019-0706

WAIVER AND RELEASE

ONLINE REGISTRATION CLOSING DATE

Wednesday April 18, 2012 @ 5:00 EST

Legal Waiver & Signature: I hereby certify that I have carefully read, understand, and agree to be bound by the terms contained within this Entry Form and will be legally bound by terms of this release (waiver of rights). I certify that I have entered this race of my own free will. I am in a physical condition that allows me to enter this event. In consideration of the acceptance of my entry, I do, for myself, my heirs, administrators, executors, and any, and all parties, related to or representing me waive and release now and forever any and all claims, damages, known or unknown, now or in the future, I have, or may have in the future against The EZ Memorial Foundation, The EZ Memorial Run, Kalamazoo Department Public Safety, Kalamazoo Valley Community College, its principals, representatives, sponsors, volunteers, and or beneficiaries, for any and all injuries, claims, damages, or right to bring any type of claim, suffered by me while traveling to, from, and while participating in the race event. Further, I accept full responsibility and liability for any, and all medical expenses, claims, or damages of any kind, that I may incur, and agree to defend and indemnify, the above named parties, if any claim is brought against them by any party on my behalf. I also waive any, and all rights of privacy I may have and agree that my photograph, likeness, or video may be used by race organizers, their representatives, agents, or any other party they grant permission to, to take and use, said photographs, film, video, or other digital likeness. NOTE: PARENT MUST SIGN IF PARTICIPANT IS UNDER 18 AND PARENT OR GUARDIAN UNDERSTANDS AND AGREES THAT THEY ARE WAIVING THE RIGHTS OF THE MINOR BY SIGNING THIS RELEASE AND WAIVER, TO THE FULL EXTENT ALLOWED BY MICHIGAN LAW.

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_________________________________________________________________________________________________________ Signature or Signature of Parent if under 18 Date