Open to the Public SEMPER FIDELIS MARINE CORPS BASE HAWAII No USMC or Federal Government endorsement of sponsors. Saturday, June 10, 2017 6:30 AM • The Officers' Club Individuals $25 (Late fee $10, begins June 3, 2017) REGISTER & PAY ONLINE (Online registration closes on June 6, 2017) www.MCCSHawaii.com/SurfandTurf5k ALL CIVILIANS (NON-DOD) MUST REGISTER 10 DAYS PRIOR TO THE RACE. For more information call 254-7590 Turn Around The Officers' Club FINISH START FEE & REGISTRATION • Individuals: $25 (includes T-shirt) • Walk-in registration is accepted at the Semper Fit Center reception desk, Bldg 3037 and the General Louis H. Wilson Fitness Center, Camp Smith • Online registration closes June 6, 2017 • Late registration begins June 3. Late registration is $35 and no T-shirt is guaranteed • Make checks payable to MCCS 0910 • On-site registration will be accepted morning of the race for authorized patrons only and no T-shirt is guaranteed PACKET PICKUP • Thursday, June 8 MCBH Kaneohe Bay Front Gate 1:00-6:00 PM for Civilians, DoD Employees, Active Duty & Retired Military • Friday, June 9 10:00 AM-4:00 PM at Kaneohe Bay Semper Fit Center for DoD Employees, Active Duty & Retired Military • Packets may also be picked-up the morning of the race AWARDS • Top three finishers overall (Men & Women) • Top three finishers in each age division (Men & Women) Please Print Clearly In Ink & Complete Fully T-Shirt Size: S__ M__ L__ XL__ (All Adult Sizes) Last Name: __________________________ First Name:_________________________________ Address:_____________________________________ City:__________________________________ State:___________________ Zip:__________________ Gender: Male Female Birthdate:______________ Age:_______ Work Phone:____________________________ Cell Phone:_________________________ Email:___________________________________________ ONLY HI Driver’s License # _____________OR Social Security # _____________ OR Active Duty Status & Rank ___________________________ Entry Fee: $25 individual Late Entry Fee: $35 (no T-shirt guaranteed, begins June 3) Number of EXTRA T-Shirts @ $10 each (All Adult Sizes): S__ M__ L__ XL__ Total Enclosed: $______ Make Checks Payable To: MCCS 0910 All Checks Must Have Name, Current Address, Two Phone Numbers and Rank (if applicable) Mail To: MCCS · Box 63073 · MCBH, Kaneohe Bay HI 96863-3073 · ATTN: Athletics/Fitness MCBH MAJOR COMMAND: Check Unit box if applicable HQBN CAMP SMITH 3D RADIO BN HSM-37 VMM-268 MALS-24 MAG-24 1/12 3D MARINES CLB-3 CPRW-2 MCAS VP-9 OTHER________ HOLD HARMLESS AND WAIVER OF LIABILITY AGREEMENT (must be signed) In consideration for me and/or my son/daughter to participate in the Marine Corps Community Services (MCCS) Surf & Turf 5K Run at Marine Corps Base Hawaii, (hereinafter called event), I hereby take the following actions for myself or anyone else who might claim or sue on my behalf: (a) I acknowledge that the event includes running activities and is an arduous test of a person’s physical and mental limits and carries with it the potential for death, collision, serious injury and property loss; (b) I acknowledge that certain detrimental physiological changes may occur while I participate in the event, including but not limited to heat exhaustion and stroke; abnormal heart beat; abnormal blood pressure; and, in rare instances, heart attack; (c) I acknowledge that there may be other participants in the event and that their actions may be unpredictable; (d) I certify that I am physically fit and have not been advised against participation in the event by a qualified health professional; (e) I agree that, prior to participating in the event, I will inspect the event facilities, equip- ment, and areas to be used and if I believe any are unsafe, I will immediately advise a person supervising the event; (f) I assume all risks associated with the event, including, but not limited to adverse road conditions; falls; contact with other participants, effects of weather, my personal physical condition; motor vehicles on the event course; and lack of hydration; and (g) In connection with the event, I forever release from all liability under the Federal Tort Claims Act, acquit and discharge from all known obligations, losses, damages, liabilities, injuries, claims, demands, actions, causes of action and expenses, including without limitation, attorney’s fees and costs, the following persons or entities: United States Government including MCCS and the United States Marine Corps, and the employees, representatives, sponsors and agents of the above. (h) I further grant full permission to the United States Marine Corps and Marine Corps Community Services to use any photographs or media taken by MCCS of me (or my child) for any purposes. I understand that I do not own the images and no further payments are due to me in regards to them. Signature (Parent/Guardian if under 18 years of age) Date.