Justin Foundation 5K Scholarship Run


Damascus Town Park, Damascus, VA

5/21/2016


8am - 5K Run
8:30am - One Mile Fun Run

Pre-registration:
(ends 5/5/2015)
$15 - 5K
$5 - One Mile Fun Run
| Regular
| Registration:
$20 - 5k
$10 - One Mile Fun Run
SFTC King & Queen race: SFTC members receive preregistration discount
Make checks payable to: Justin Foundation
Mail this form to: PO Box 656
Damascus, VA 24236
Only preregistered runners are guaranteed a shirt.
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
David Matlock
(276)475-6043
Justin Foundation 5K Scholarship Run
Male & Female Awards:

Overall (top 3)
Masters (top 3)
GrandMasters (top 3)

Age Groups (top 3)
...15,16-20,21-25,26-30,31-35,36-40,41-45,46-50,51-55,56-60,60...

Justin Foundation 5K Scholarship 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: 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)


This entry form was generated with the SFTC Calendar Utility at www.runtricities.org