7am-7:45am - race-day registration 8am - 5K Run 8:05am - 5K Walk All proceeds will go to the Women's Cancer Network!! Door prizes, medals to top 3 in each age group. $50 GIFT CARD TO TOP OVERALL MALE/FEMALE. THREE MONTH membership to Lifestyles Fitness center to winner. T-shirts to all pre-registered participants. Must have a google account to view first website. Must have a facebook account to view the 2nd event website |
| Pre-registration: (ends 7/21/2010) |
$15 - 5K Run $12 - 5K Walk | | Regular | Registration: |
$18 - 5K Run $15 - 5K Walk | |
| Make checks payable to: DBA 2010 ETSU PT 5K | ||||
| Mail this form to: ETSU Care of Bonnie Craig 8 University Parkway Box 14479 Johnson City, TN 37614 | ||||
| Only preregistered runners and walkers are guaranteed a shirt. Door prizes and goodie bags will also be given out. Top 3 from each age group will receive a medal, with top male and female receiving plaque and $50 gift cards. |
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact Rachel Pierce 423-895-1722 zrlp22@goldmail.etsu.edu | ETSU Physical Therapy 5K Male & Female Awards: Top Overall Masters (top 3) GrandMasters (top 3) Sen.GrMasters (top 3) Top Age Groups 10&under,11-15,16-20,21-25,26-30,31-39,40-49,50-59,60+ | 5K Walk Male & Female Awards: Top Age Groups No awards will be given for 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)_________________________________________ |
*** CIRCLE EVENT: ETSU Physical Therapy 5K | 5K Walk |
*** CIRCLE SHIRT SIZE: SM, MD, LG, XL, |
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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. |
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SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |