Laura's 5K Run/Walk


Wise County Christian School 5913 Airport Road, Wise VA 24293, Wise, VA

8/16/2014


9:00 am - 5K Run and 5K Walk (un-timed). Benefits the Laura Danielle Wampler Foundation. $25 discount for groups of 5 or more. Professional event management by We Run Events.

Pre-registration:
(ends 8/14/14)
$20 by 8/14/14
$25 discount for groups of 5 or more. Please send all entry forms together.
| Regular
| Registration:
$25 after 8/14/14
Make checks payable to: Wise County Christian School
Mail this form to: Wise County Christian School PO Box 3297 Wise Va 24293
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Amy Ketron, ayhopkins@hotmail.com, 276-210-7029
Laura's 5K Run
Male & Female Awards:

Top Overall

Age Groups (top 3)
15u, 16-19, 20-29, 30-39, 40-49, 50+
5K Walk (Untimed)
Male & Female Awards:



Age Groups (top 3)
Untimed walk, no awards.

Laura's 5K Run/Walk

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 EVENT: Laura's 5K Run | 5K Walk (Untimed)

*** 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)


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