5

5K
SATURDAY, MARCH 5th 2011 - 8 AM

Event is in Collaboration with the

40th Annual Bartow Bloomin’ Arts Festival Weekend
Registration Begins at 7:00 AM  
Race Starts at Fort Blount Park in Historic Downtown Bartow, (E. Main & S. Broadway Ave.)
A 5K Run & Fun Walk. It is a rain or shine event.
Commissioner Bob English, Race Chairman & Lakeland Runners Club, Race Manager
My 
Call 863.804.0494 or register at Active.com – email:director@polkartsalliance.org or www.polkartsalliance.org

REGISTRATION FORM
Name: _________________________________________________________________________________________________
Address: ___________________________________________________________City____________________Zip__________
Phone: ________________________________ Email: ___________________________________________________________
Age on Race Day: __________Male_____Female_____ CHECK: Walker______Runner_______ (incomplete Forms NOT Processed)
CIRCLE T-SHIRT SIZE: S M L XL XXL register race day 5.00 extra
Entry fees (nonrefundable) $15 Adults - $10 Students (9th grade-college) - $5 Students (1st grade – 8th grade)
Make Checks Payable to: Polk Arts Alliance, Inc. Mail to: PAA, P.O. Box 727, Bartow, FL 33831
In consideration of this entry, I hereby for myself, my heirs, my executor and administrators; waive, release and discourage all claims I may have
against the Polk Arts Alliance, the City of Bartow, Polk County and its representatives, sponsors, volunteers, participating agencies, sponsors and
officials for any and all damages and injuries of any manner resulting from my participation in PAA’s Race for the Arts 2011. I further state I am
physically fit and sufficiently trained to participate in this race. I also grant permission to any of the sponsors or officials to use my likeness in
connection with this race.
Signature_________________________________________Date____________ (Parent/Legal Guardian must sign if under 18)
The Polk Arts Alliance is a non profit 501(c)3 tax exempt corporation in the State of Florida. This is a fundraiser for PAA and the Arts and Cultural
Organizations of the Cultural Arts Board of Polk County.