First Bap ist Church WORKING, WITNESSING & WINNING SOULS FOR CHRIST

and

PROUDLY PRESENT

FREE EVENT FOR ALL

Date of Event: September 17, 2011

Location: Central City Park

Registration/Line-up: 7:00 a.m. - 7:50 a.m.

Walk/Run: PROMPTLY at 8:15 a.m.

Additionally, there will be information on HEALTHY LIFESTYLES

and interactive activities for KIDS and ADULTS

Registration Form mandatory for participation

Children under age 18 required to register and to have a parent PRESENT

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Participant Name (PRINT) Street Address City State Zip ______________________ _________________________________________________________________

Phone Number Emergency contact (name and telephone number)

________________________________________________________ Circle T-Shirt Size

Email address S M L XL

Waiver of Liability: I understand and agree to hereby release and hold harmless First Baptist Church and

the City of Macon, its officers, members and staff, and any other participating sponsor from any and all

liability including but not limited to injury, damage, or economic loss associated with my participation in

the aforementioned Fun, Walk & Run. I am able to participate in this Event without harm to myself or

others. I hereby grant First Baptist Church, 595 New Street, Macon, GA the irrevocable right to use and

publish, for any purpose whatsoever and without compensation, any photographs, video recordings, or

motion pictures of my likeness, voice, portrait in connection with my participation in the Event.

FRIENDS AND FAMILY

FUN WALK & RUN

MACON!

First 50

participants to

register are

guaranteed a

T-Shirt!