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www.smegs-legs.org Proceeds to benefit: Access Sports America Houghs Neck Community Council Scholarship Broad Meadows Middle School Athletics $20 Entrance Fee before 9/29/12 Online registration deadline 10/4/12 $25 Entrance Fee on day of the race $10 Entrance Fee Students through grade 12 Raffles and Silent auction T-Shirts to the 1st 350 registrants! Prizes for 1st, 2nd and 3rd place: DIVISIONS: Male, Female, Student, Clydesdale, Wheelchair, Military & Prize for Best Costume Saturday October 6, 2012 9:00 AM – 12:00 PM Broad Meadows Middle School, Quincy 5 Mile Run / 2 Mile Walk Chris Smeglin, an Atherton Hough, Broad Meadows, BC High Alum, and graduate of the US Merchant Marine Academy in Kings Point, NY, had an unquenchable zest for life, unique sense of humor and deep compassion for the needy. After enlisting in the US Navy to fulfill a lifelong ambition to serve his country and become an aviator, Navy LTJG Chris Smeglin, a 24-year-old Houghs Neck, Quincy resident, was tragically killed on October 2, 2008 during a bike training session for a triathlon. Join us to remember Chris and continue his cause at the 4th Annual Smegs Legs Run. Registration begins at 7:30 AM at Broad Meadows Middle School, 50 Calvin Road, Quincy, MA 02169 REGISTRATION FORM I hereby for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against the sponsors, coordinating groups and any individuals associated with the event, the representatives, assessors and assigns will hold them harmless for any and all injuries suffered in connection with this event. I attest that I am physically fit to compete in this race. Further, I grant full permission to any and all of the foregoing to use my photographs, videotapes, motion pictures, recordings or any other records of this event for any legitimate purpose. SIGNATURE: __________________________________________________________________DATE: ______________________________ Full Name: ________________________________________ Address: _________________________________________ City: ______________________ State: _____ Zip: ________ Phone: ___________________________________________ E-mail: ____________________________________________ Size: S ___M ___L ___XL ___XXL___ Div: M ___F ___Student___Wheelchair___Clyde___Mil.___ DOB: _____/_____/_______ Age on race day: ________ Please mail check along with registration form to: Chris Smeglin Memorial Fund c/o Jane & Mike Smeglin 125 Spring Street Quincy, MA 02169 * Checks payable to Chris Smeglin Memorial Fund. ___5 Mile Run ___2 Mile Walk ___Donation 4 th Annual

Smegs legs 2012 registration form

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Page 1: Smegs legs 2012 registration form

www.smegs-legs.org Proceeds to benefit:

Access Sports America Houghs Neck Community Council Scholarship

Broad Meadows Middle School Athletics

$20 Entrance Fee before 9/29/12 Online registration deadline 10/4/12 $25 Entrance Fee on day of the race $10 Entrance Fee Students through grade 12 Raffles and Silent auction

T-Shirts to the 1st 350 registrants!

Prizes for 1st, 2nd and 3rd place: DIVISIONS: Male, Female, Student,

Clydesdale, Wheelchair, Military & Prize for Best Costume

Saturday October 6, 2012

9:00 AM – 12:00 PM Broad Meadows Middle

School, Quincy 5 Mile Run / 2 Mile Walk

Chris Smeglin, an Atherton Hough, Broad Meadows, BC High Alum, and graduate of the US Merchant Marine Academy in Kings Point, NY, had an unquenchable zest for life, unique sense of humor and deep compassion for the needy. After enlisting in the US Navy to fulfill a lifelong ambition to serve his country and become an aviator, Navy LTJG Chris Smeglin, a 24-year-old Houghs Neck, Quincy resident, was tragically killed on October 2, 2008 during a bike training session for a triathlon.

Join us to remember Chris and continue his cause at the 4th Annual Smegs Legs Run.

Registration begins at 7:30 AM at Broad Meadows Middle School, 50 Calvin Road, Quincy, MA 02169

REGISTRATION FORM

I hereby for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against the sponsors, coordinating groups and any individuals associated with the event, the representatives, assessors and assigns will hold them harmless for any and all injuries suffered in connection with this event. I attest that I am physically fit to compete in this race. Further, I grant full permission to any and all of the foregoing to use my photographs, videotapes, motion pictures, recordings or any other records of this event for any legitimate purpose. SIGNATURE: __________________________________________________________________DATE: ______________________________

Full Name: ________________________________________ Address: _________________________________________ City: ______________________ State: _____ Zip: ________ Phone: ___________________________________________ E-mail: ____________________________________________ Size: S ___M ___L ___XL ___XXL___ Div: M ___F ___Student___Wheelchair___Clyde___Mil.___ DOB: _____/_____/_______ Age on race day: ________

Please mail check along with registration form to:

Chris Smeglin Memorial Fund c/o Jane & Mike Smeglin 125 Spring Street Quincy, MA 02169

* Checks payable to Chris Smeglin

Memorial Fund. ___5 Mile Run ___2 Mile Walk ___Donation

4th Annual