Lee Bank 29th Annual Steven Rowlett Memorial Road Race


Lee Bank, Pennington Gap, VA, Pennington Gap, VA

10/26/2019


8:30 a.m. 1 Mile Fun Run
9:00 a.m. 5K Road Race

Pre-registration:
(ends 10/19/19)
$8.00, if received by October 19, 2019 | Regular
| Registration:
$10
Make checks payable to: Steven Rowlett Road Race
Mail this form to: Steven Rowlett Road Race
P.O. Box 100
Pennington Gap, VA 24277
Or Drop By Any Lee Bank Location
$1.00 Discount for SFTC Members
Trophies for Male and Female Overall and for Top Three in Each Age Group

Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
276-546-2211 or 276-546-1210
29th Annual Steven Rowlett Memorial Road Race 5K
Male & Female Awards:

Overall (top 3)
Masters (top 3)

Age Groups (top 3)
10 & under; 11-14; 15-19; 20-24; 25-29; 30-34; 35-39; 40-44; 45-49; 50-54; 55-59; 60-69; 70 & over

Lee Bank 29th Annual Steven Rowlett Memorial Road Race

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)


This entry form was generated with the SFTC Calendar Utility at www.runtricities.org