AmaXIng Challenge Step It Up 5K to Benefit Autism Speaks


Civitan Park, 1000 Broadway St., Johnson City, TN

4/3/2015


8:00 pm. Note the change to Friday evening. Beautiful course through the historic Gump Addition in Johnson City. Presented by the women of Alpha Xi Delta Gamma Theta Chapter at ETSU. The event is to raise awareness and benefit for Autism Speaks, Alpha Xi Deltas national philanthropy partner. Refreshments will be provided before, during and after the race. The AmaXIng Challenge will be professionally managed by We Run Events with electronic B-tag timing.

Pre-registration:
(ends 4/2/15)
$20 | Regular
| Registration:
$25
Make checks payable to: Alpha Xi Delta
Mail this form to: c/o Emily Samples
537 Calvin Phillips Dr.
Johnson City, Tn 37601
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Kelsey King-Hook, kinghook@goldmail.etsu.edu
AmaXIng Challenge 5K
Male & Female Awards:

Top Overall

Age Groups (top 3)
14U, 15-19, 20-29, 30-39, 40-49, 50-59, 60+

AmaXIng Challenge Step It Up 5K to Benefit Autism Speaks

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

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