8am Run 5K charity / fun run. In 2011 you donated 750+ lbs of food! All ages & abilities welcome! |
| Pre-registration: (ends 11/16/2012) |
Free T-shirts to those that pre-register only. (registration must be received by 11/15/11) Cost is a donation of at least 2 non-perishable food items. | | Regular | Registration: |
Race day registration is available but T-shirts will only be available to those who pre-register. | |
| Mail this form to: Mail/ drop at Shepard's Center or c/o Ann Marie Forster -West Main Medical Center 900 W Main St Rogersville, TN 37857 | ||||
| This is a family fun run/ walk through historic Rogersville to raise canned goods for the food pantry at Of One Accord Ministries. Runners/walkers/strollers are asked to move to the sidewalks to open the roads back up to traffic after 45 min.. |
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact Tony Forster (423) 923-0141 | 5k GiveThanks Family Fun Run Male & Female Awards: ...0,0... |
| LAST NAME__________________________________ FIRST NAME_________________________ M.I._______ |
SEX____ DATE OF BIRTH____/____/____ AGE ON RACEDAY_____ E-MAIL____________________________ |
ADDRESS___________________________________________________________________________ |
CITY________________________ STATE_________ ZIP___________ PHONE (_______)_______-___________ |
RACE DAY EMERGENCY CONTACT (NAME AND PHONE)_________________________________________ |
*** CIRCLE SHIRT SIZE: YS, YM, YL, SM, MD, LG, XL, |
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IN CONSIDERATION FOR ACCEPTING MY ENTRY IN THIS RACE, I FOR MYSELF, MY HEIRS, EXECUTORS AND ADMINISTRATORS, WAIVE AND RELEASE FOREVER ANY AND ALL RIGHTS AND CLAIMS FOR DAMAGES I MAY HAVE AGAINST THE ORGANIZERS AND SPONSORS OF THIS EVENT. I ALSO RELEASE THE ABOVE NAMED FOR ALL CLAIMS OF DAMAGE DEMANDS, AND ACTIONS IN ANY MANNER DUE TO ANY PERSONAL INJURIES, PROPERTY DAMAGE, OR DEATH SUSTAINED AS A RESULT OF MY TRAVELING TO AND FROM AND MY PARTICIPATION IN SAID RACE. I ATTEST AND VERIFY THAT I AM PHYSICALLY FIT AND HAVE SUFFICIENTLY TRAINED FOR THE COMPETITION OF THIS EVENT. IN FILLING OUT THIS FORM, I ACKNOWLEDGE I HAVE READ AND FULLY UNDERSTAND MY OWN LIABILITY AND ABILITY. |
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SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |