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


Meadowview Convention Center
, Kingsport, TN

12/11/2021


8 AM 5K Run/Walk. All proceeds go to the Hope House of Kingsport. Hope House of Kingsport helps men and women in crisis who are expecting a baby. Hope House of Kingsport helps men and women in crisis who are expecting a baby. The race is in memory of Melissa Mingle. She was a local pregnant woman who was killed in 2019 as a result of a domestic dispute. The course will start and finish at Meadowview Convention Center and run on the beautiful Cattails Golf Course. Nice long sleeve shirt for all entrants.

Pre-registration:
(ends 12/9/21)
$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

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)


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