Race begins: 8:00 P.M |
| | Regular | Registration: |
$25.00 $100.00 for a team of five Family and Friends Team Challenge is open to any group and any number of team members. Entry forms for all members of a team must be submitted together. | |||
| Make checks payable to: Town of Pound Heritage Days | ||||
| Mail this form to: Town of Pound P.O. Box 880 Pound, Va 24279 | ||||
| Official race shirt is guaranteed to the first 30 runners to register. Remaining runners may receive a shirt at a later date. |
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact Leabern Kennedy 276-393-3119 | Pound Herirage Days Glowin Down In The Pound 5K Glow Run Male & Female Awards: Top Overall Top Masters Top GrandMasters Age Groups (top 3) …14, 15-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+ |
| 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)_________________________________________ |
TEAM NAME____________________________ |
*** 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) |