Hope House Dream 5K Run/Walk Presented by Birth Tissue Donor Services


Centennial Park, 245 E. Main St., Kingsport, TN

12/14/2019


8 AM 5K Run/Walk. All proceeds go to the Hope House of Kingsport. Hope House of Kingsport helps men and women who in crisis that are expecting a baby. The course is a very fun double loop course in downtown Kingsport. Should be flat and fast!

Pre-registration:
(ends 12/12/19)
$25 | Regular
| Registration:
$30
Make checks payable to: Birth Tissue Donor Services
Mail this form to: Birth Tissue Donor Services
Re: Hope House Dream Run
2016 Hwy 75, Suite 2
Blountville, TN 37617
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Patrick, patricka@birthtissuedonor.com, 423-341-0617
Hope House Dream Run 5K
Male & Female Awards:

Top Overall
Top Masters
GrandMasters (top 3)

Age Groups (top 3)
14 under, 15-19, 20-29, 30-39, 40-49, 50-59, 60 over

Hope House Dream 5K Run/Walk Presented by Birth Tissue Donor Services

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, 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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