9am - 1 Mile Kids Run 9:30am - 5k Note: Course map has been revised! (10/15/12) |
| Pre-registration: (ends 10/13/2012) |
Only preregistered 5k participants guaranteed a shirt! | | Regular | Registration: |
$10-1 mile $15-5k price for VHCC Family - alumni, employees, students, future students $20-5k price for everyone else $2 discount to STFC members. All proceeds benefit the Dr. Deborah C. Clear Scholarship. | |
| Make checks payable to: VHCC Foundation and please put 'CSSA 5k' in the memo section | ||||
| Mail this form to: Candace McClure Virginia Highlands Community College PO Box 828 Abingdon, VA 24212 | ||||
| ***CIRCLE EVENT***________5K RUN/WALK________1MILE KIDS FUN RUN Kids mile participants will receive a piggy bank. Special awards given out to first 3 to catch Big Bad Wolf. If they can! Door Prizes! |
| Headphones are permitted on the course | Strollers are NOT permitted on the course |
| For more info contact Adam Parks aparks@vhcc.edu 276-701-3169 | VHCC's Catch the Big Bad Wolf 5k & 1 MIle Little Piggy Fun Run Male & Female Awards: Overall (top 3) Masters (top 3) GrandMasters (top 3) Age Groups (top 3) ...14,15-19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60... |
| 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, XXL |
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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. STROLLERS ARE NOT ALLOWED ON THE RACE COURSE. |
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SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |