Mendota 5K River Run


Mendota,Va., Mendota, VA

3/11/2017


5K 9 a.m. 1 Mile Fun Walk 9:15

Pre-registration:
(ends 03/01/17)
$20 for 5K, $10 for Fun Walk | Regular
| Registration:
$25 for 5K, $10 for Fun Walk
SFTC King & Queen race: SFTC members receive preregistration discount
Make checks payable to: Mendota Community Association (MCA)
Mail this form to: Wayne Hays
2567 Mendota Rd.
Mendota, Va. 24270
Plenty of Door Prizes
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Wayne pitonina@bvu.net
276-591-1928 No calls after 8 p.m.
Mendota 5K River Run
Male & Female Awards:

Top Overall

Age Groups (top 3)
9 and under, 10-14, 15-19, 20-24, 25-29,30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70+

Mendota 5K River Run

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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