5K

[wrcoach02]

1st Annual 5K
Run for the Dragons
Jim Mayo Stadium
Fairland Track
Saturday, August 6th, 2011



See www.tristateracer.com for complete information.
Race Day Online Registration tristateracer.com and race day registration will begin at 7:30 at Jim Mayo Stadium.
Course The course is fast and flat through Rome. It will begin and near the Track.
Entry Fee Pre-registration before July 15th is $15. Registration the day of the race will be $20.
T-shirts The first 100 will receive a t-shirt. In order to guarantee a size, please pre-register.
Awards Awards will be given to the first place male and female finisher, and the top two finishers, male and female, in each of the following age groups: 13 & under, 14-19, 20-29, 30-39, 40-49, 50-59, 60 & Over. No duplication of awards.
Contact Information Chuck Wentz 304-544-5816 or [email protected]
Online Entry Tristateracer.com or Mail Entry Form & Payment to:
Fairland Athletic Boosters
PO Box 289
Proctorville, OH 45669
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One participant per entry form. Please duplicate if necessary.

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Last Name First Name Age

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M/F Street Address

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City State Zip Telephone

Circle Shirt Size: Youth LG Adult S Adult M Adult L Adult XL Adult XXL

In consideration of being permitted to participate in the 1st Annual 5K Race Dragons Run for the Children, I do hereby for myself, my heirs, executors and administrators and assignees, release, discharge, save and hold harmless and agree to indemnify all those persons involved in organizing and manning, including volunteers, corporate sponsors, media sponsors, business donors and any other participants, this event from all claims, demands, losses, damages, actions, causes of actions or sits of whatsoever kind or nature, arising out of my participation in the race on August 6th, 2011. In addition, I attest that I am sufficiently fit and prepared for this event.

Signature_______________________________________________Date_________________

Waiver MUST be signed by all participants, or, if participant is under 18 years of age, by a parent or legal guardian.