FCA-Wise Fall Fling 5K


Wise First Church Of God
702 E Main St.
, Wise, VA

10/9/2021


Registration begins: 8:00 A.M.
Race start: 9:00 A.M.

Pre-registration:
(ends 10/2/2021)
$15.00 | Regular
| Registration:
$20.00
Make checks payable to: FCA
Mail this form to: Gary Maggard
7956 Rock Switch Rd.
Wise, Va. 24293
A pancake breakfast will be provided from 8:00 A.M. to 11:00 A.M. to runners with a race bib or tickets may be purchased for $6.00. Size XXL shirts are available for an additional $2.00 and ONLY by pre-registration.
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Gary Maggard (276) 365-0721
gmaggard@fca.org
FCA-Wise Fall Fling 5K
Male & Female Awards:

Overall (top 3)
Top Masters
Top GrandMasters
Top Sen.GrMasters

Age Groups (top 3)
...9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75+

FCA-Wise Fall Fling 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 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