5K charity / fun run.
In 2011 you donated 750+ lbs of food!
All ages & abilities welcome!
|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
|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:
|LAST NAME__________________________________ FIRST NAME_________________________ M.I._______|
SEX____ DATE OF BIRTH____/____/____ AGE ON RACEDAY_____ E-MAIL____________________________
CITY________________________ STATE_________ ZIP___________ PHONE (_______)_______-___________
RACE DAY EMERGENCY CONTACT (NAME AND PHONE)_________________________________________
*** CIRCLE SHIRT SIZE: YS, YM, YL, SM, MD, LG, XL,
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.
SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18)