Third Annual 5K Give Thanks Family Fun Run


Shepard's Center
306 E. Main St
Rogersville, TN 37857, Rogersville, TN

11/22/2012


7am Registration
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:




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Third Annual 5K Give Thanks Family Fun Run

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,

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)


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