Valley Health Care/Iron Mtn Riders 5K Glow Run/St Jude Children's Hospital/ Memorial Walk for Mike Greer


registration on front porch of Valley Health Care Center, 940 E Lee Highway, Chilhowie, VA
race begins beside Loaves and Fishes Food pantry, Chilhowie, VA

6/2/2018


Registration from 7:00 pm to 8:15 pm
Race Begins at 8:30 pm

Pre-registration:
(ends 05/28/2018)
$20 for adults, $15 for kids



| Regular
| Registration:
$25 for adults, $20 for kids
Make checks payable to: Valley Health Care Employee Council or St Jude Children's Hospital
Mail this form to: VHCC Employee Council, P O Box 748, Chilhowie VA 24319
Only preregistered are guaranteed a tshirt, Glow sticks provided to all runners
Best dressed adult and kid award,
Headphones are NOT permitted on the course | Strollers are NOT permitted on the course
For more info contact
Debbie Blankenship 276-608-4983, dblankenship@care-one.com
Karla Blevins 276-646-4332
Valley Health Care/Iron Mtn Riders 5k Glow Run/Walk for St Jude Children's Hospital
Male & Female Awards:

Top Overall
Top Masters
Top GrandMasters

Age Groups (top 3)
19 & under, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60 +...

Valley Health Care/Iron Mtn Riders 5K Glow Run/St Jude Children's Hospital/ Memorial Walk for Mike Greer

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: YM, YL, 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. STROLLERS ARE NOT ALLOWED ON THE RACE COURSE. PARTICPANTS USING HEADPHONES ARE NOT ALLOWED ON THE RACE COURSE.

SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18)


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