Colors of Cancer 5K Run/Walk


Burkes Garden Community Center, Burkes Garden, VA

4/28/2018


9:00 am. Burkes Garden Community Center. Beautiful color run through the Burkes Garden Community. Packet Pickup and Late Registration until 8:30 am, Saturday April 29th. Electronic timing and professional race management by We Run Events.

Pre-registration:
(ends 4/17)
$30 5K
$20 18 under
| Regular
| Registration:
T-shirts not guaranteed after 4/17
$35 5K
$25 18 under
Make checks payable to: Team Burkes Garden
Mail this form to: Team Burkes Garden
c/o Jamie Hayes
320 Walker Street
North Tazewell, VA 24630
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Angela Leighton, aleighton814@gmail.com
5K Run/Walk
Male & Female Awards:

Top Overall
Top Masters

Age Groups (top 3)
14 under, 15-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70+

Colors of Cancer 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 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)


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