Restore Your Sole 5K Run/Walk


Virginia Creeper Trail, Green Spring Road, Abingdon, VA, Abingdon, VA

4/1/2017


8:00 AM Registration / 9:00 Race / Awards Follow
Race to proceeds will benefit the Haven of Rest Rescue Mission and will help the homeless and hungry of the Mountain Empire.

Pre-registration:
(ends 03/24/2017)
$20 - 5K Run/Walk | Regular
| Registration:
$25 - 5K Run/Walk
Make checks payable to: Haven of Rest Rescue Mission
Mail this form to: Haven of Rest Rescue Mission
624 Anderson Street
Bristol, TN 37620
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Brian Plank / bristolmission.ddcr@gmail.com /423-383-7729
Jill Rust / bristolmission.mkt@gmail.com / 423-968-2011
Restore Your Sole 5K Run/Walk
Male & Female Awards:

Overall (top 3)
Masters (top 3)
GrandMasters (top 3)

Age Groups (top 3)
...19,20-29,30-39,40-49,50-59,60...

Restore Your Sole 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: SM, MD, LG, XL,

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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