Freedom 5K


Holston Hills Community Golf Course
1000 Country Club Rd, Marion VA 24354, Marion, VA

5/26/2018


8:00 am - Brief Memorial Day Ceremony at 7:30 am
A 5K run/walk in honor and in memory of our military. There will be a brief ceremony at 7:30 am to kick off this family event. Blue and red color will be added to the white shirts during the run/walk.

Pre-registration:
(ends 5/13/2018)
$25 before 5/13/18 with guaranteed tshirt; Kids are free (optional shirt is $12) | Regular
| Registration:
$30 after 5/13/18 without a guaranteed tshirt
Make checks payable to: Smyth County Chamber of Commerce
Mail this form to: 214 West Main Street, Marion VA 24354
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Smyth County Chamber of Commerce
214 West Main St, Marion, VA 24354
276-783-3161
info@smythchamber.org
Freedom 5K
Male & Female Awards:




All Ages run together. Not recommended for children under 15 years of age. Anyone under 18 years old must be accompanied by a responsible adult. an adult.

Freedom 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)_________________________________________

*** CIRCLE SHIRT SIZE: YS, YM, YL, 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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