2017 Shelby County Education Foundation Race for Education

University of Memphis Campus § Saturday, 10/28/17 § 5K Race at 9:00 a.m. MEDALS FOR 5K WINNERS! WHEELCHAIRS AND STROLLERS ARE WELCOME! ”RAIN OR SHINE” FOR SAFETY, NO DOGS, BICYCLES, ROLLERBLADES, ROLLER SKATES, OR SKATEBOARDS Net proceeds from registration fees will go directly to the designated schools in Shelby County Schools’ art, music, P.E., and/or other specialty programs. You may designate where you would like the net proceeds of your registration to go below. The Race for Education is a function of the Shelby County Education Foundation, a nonprofit 501(c)(3) organization dedicated to supporting public schools in Shelby County. ONE ENTRANT PER FORM. E arly B ird R e g i s tr at ion on or b e fore 1 0 / 20 / 1 7 is $15 for students and $20 for adults. You may also register at w ww. r a ce f o r e d u ca ti o n. c o m. Online registration closes 10/25/17. Registration on Race Day begins at 8 a.m. and ends at 8:45 a.m. To ensure receiving a T-Shirt on Race Day, please register on or before October 15, 2017. T- shirts not guaranteed after 10/15/17.

First Name Last Name

Date of Birth (MM-DD-YYYY)

E-mail Address

AGE Ch e c k T-s h irt si z e : Adult S___ Adult M____ Adult L___ Adult XL___ Adult 2X ___ Child S ___ Child M__ Child L Gender:___MALE _____FEMALE Please specify donation* for: School listed below F Race for Education * P.O. Box 383273 * Germantown, TN 38183- 3273 Questions: 901- 416-7396 School Name (Please specify Elementary, Middle, or High School)

Teacher Name if known

Emergency Contact Name LIABILITY RELEASE FORM Emergency Contact Phone (Must be signed):

Please Specify 5K Run/Walk Of this entry in the 5 K Ghost Run/Walk and/’or 1 Mile Family Fun Walk on October 28, 2017, Runner/No I, for myself and my heirs and assigns, release SCEF Race shirt OR for Education and all other with sponsors and organizations assisting with the events shirt (CIRCLE) including parking, busing, and MRTC Member? Yes # Shelby County Board of ***MRTC Members receive Education, its employees, elected officials, and agents $1 registration discount from any and all claims for injury incurred by me as a result of my participation, and will assume responsibility for Street Address (Include Apartment Number) any and all claims or injuries. I also grant permission to any and all of the foregoing to use any photographs, videotapes, motion pictures, and/or recording for any purpose whatsoever.

City State Zip Code Participant Signature Date * u p si

Daytime Phone Ma k e c h e c k s ( $15 o n o r b e f o re 10 / 20 / 17 $ 20 th erea f t er for students and $25 adults) Payable to SCEF Race for Education Deliver this form to your local School’s Race for Education S Chairperson or send (10/20/17) completed form/forms with check C to: E