5th Annual Dairy Queen Turkey Day 5k


Norton, Virginia
Dairy Queen, Norton, VA

11/28/2019


7:30am - Registration
9am - Race
Race will start & end from the Norton Dairy Queen

T-shirt cut off date will be 11/21/2019
Only runners who have pre-registered before this date will be guaranteed a t-shirt

Awards will be given out to top overall male & female and top 3 in each age group

There will be a 1 mile walk in addition to the 5k

| Regular
| Registration:
$25 - 5k
$25 - 1 mile walk
Make checks payable to: Lonesome Pine Dairy Queen
Mail this form to: 1222 Virginia Avenue NW
Norton, VA
24273
T-shirt cut off date will be 11/21/2019
Only runners who have pre-registered before this date will be guaranteed a t-shirt

Awards will be given out to top overall male & female and top 3 in each age group
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Sarah Smith Carlson
scs6p18@gmail.com

Turkey Day 5k
Male & Female Awards:

Top Overall

Age Groups (top 3)
10 & Under, 11-19, 20-29, 30-39, 40-49, 50-59, 60+
1 Mile Walk
Male & Female Awards:



Age Groups (top 3)
0-100

5th Annual Dairy Queen Turkey Day 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 EVENT: Turkey Day 5k | 1 Mile Walk

*** 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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