EMS Strong Called To Care 5K


Creeper Trail Head, Green Springs Rd., Abingdon, VA

4/28/2017


7:30 PM. Friday evening race on the Abingdon Creeper Trail. Proceeds benefit Southwest Virginia EMS. Join in the lights and sirens theme by wearing red, white, and blue flashing lights or glow sticks. Lights and glow sticks available for purchase at the event ($2). See discount for EMS providers below. Very nice Dri-Fit t-shirts with women's and men's cuts. Event professionally timed and managed by We Run Events.

Pre-registration:
(ends 4/27/17)
$25. $5 discount for EMS providers
Those registered by Apr 18th will be guaranteed your shirt size.
| Regular
| Registration:
$30. $5 discount for EMS providers
Make checks payable to: Southwest Virginia EMS Council
Mail this form to: Southwest Virginia EMS Council
306 Piedmont Ave.
Bristol VA 24201
Awards for EMS agencies teams (4 per team). Provide your team name below.
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Maggie Long, mlong@vaems.org
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 Over

EMS Strong Called To Care 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)_________________________________________

TEAM NAME____________________________

*** 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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