Run For Your Mom 5k


Rotary Park
Run The Gump Course, Johnson City, TN

5/12/2018


5k - 9 AM start at Rotary Park (Johnson City)
We will be using the previous Run the Gump course
Race benefiting Rise Up! (http://www.riseupforkids.com)
All proceeds will help send under-resourced kids to local summer camps such as Doe River Gorge & Grace Fellowship Church's City Camp.

www.RunForYourMom.com

Pre-registration:
(ends 5/9/2018)
Race Rate (until midnight on January 1, 2018)
5k Individual…$15
| Regular
| Registration:
Race Rate (January 1, 2018- May 10, 2018)
5k Individual…$20
Late Race Registration Rate (until midnight on May 9, 2018)
5k Individual…$25
Make checks payable to: Rise Up!
Mail this form to: Rise Up!
Attn: Run For Your Mom 5k
P.O. Box 4426
Johnson City, TN 37602
Run For Your Mom benefits Rise Up!
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
RunForYourMom@gmail.com
facebook.com/RunForYourMom
Kevin Gravier @ 304-952-6229
Run For Your Mom 5k
Male & Female Awards:

Overall (top 3)
Top Masters
Top GrandMasters

Age Groups (top 3)
...9,10-19,20-29,30-39,40-49,50-59,60-69,70-79,80...

Run For Your Mom 5k

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, 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