3nd Annual Dairy Queen Turkey Day 5K


Race starts from the Dairy Queen in Norton, VA, Norton, VA

11/23/2017


8am - Registration
9am - 5k

Pre-registration: Register by 11/6/17
$20 - 5k
| Regular
| Registration:
Register after 11/6/17
$25 - 5k
Make checks payable to: Lonesome Pine Dairy Queen
Mail this form to: Lonesome Pine Dairy Queen
Attn: Turkey Day 5k
1222 Virginia Avenue NW
Norton, VA 24273
Pre-register by 11/6/17 to be guaranteed a t-shirt!
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Sarah Smith Carlson at 276-376-4514
Turkey Day 5k
Male & Female Awards:

Overall (top 3)

Age Groups (top 3)
...10,11-20,21-30,31-40,41-50,51-60,60...

3nd Annual Dairy Queen Turkey Day 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: 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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