Emory and Henry Open 5K Run and walk


Emory and Henry College Campus, 12228 Itta Bena Road,Emory, VA

11/3/2018


9:30Am-Emory and Henry 5K Run and walk

Pre-registration:
(ends 11/02/2018)
$10- Children under 12 years old
$20-Children over 12 yrs and Adults
| Regular
| Registration:
$15- Children under 12 years old
$25-Children over 12 yrs and Adults
Make checks payable to: Emory and Henry College
Mail this form to: Emory and Henry Athletics
Track and Cross Country
King Center
P.O BOX 947
Emory,VA 24327
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Coach David Cheromei
Emory and Henry College-TracK&Field and Cross Country
dcheromei@ehc.edu
434-258-4908
Emory and Henry Open 5K Run and walk
Male & Female Awards:

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


...12,13-22,23-32,33-42,43-52,53-62,60...

Emory and Henry Open 5K Run and 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)_________________________________________

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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