Missions 5K Run/Walk - Wheeler United Methodist Church


Wheeler United Methodist Church, Blountville , TN

6/24/2017


8AM 5K Run 8:15 AM 5K Walk
Proceeds to benefit Wheeler UMC Mission Funds

Pre-registration:
(ends 07/02/2016)
$25.00 | Regular
| Registration:
$25.00
Make checks payable to: Wheeler Mission Fund
Mail this form to: 211 N. Sanders St. Blountville, TN 37617
(directly across Hwy 75 from Northeast State)
Only pre-registered paid participants are guaranteed a race shirt.
Electronic course measurement by Oscar Wagner.
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Tammy Burke
tammyfstc@yahoo.com
423-361-1050
online registration with PayPal at wheelerumc.com
Missions 5K Run
Male & Female Awards:

Overall (top 3)
Top Masters
Top GrandMasters
Top Sen.GrMasters

Age Groups (top 3)
...9,10-14,15-19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60-64,65...
Missions 5K Walk
Male & Female Awards:

Overall (top 3)


...0,0...

Missions 5K Run/Walk - Wheeler United Methodist Church

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 EVENT: Missions 5K Run | Missions 5K Walk

*** CIRCLE SHIRT SIZE: XS, 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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