ShamROCK'N 5K Run/Walk


Coaltown Taps
108 Fairfax Ave., Richlands, VA

3/13/2021


5:00 pm. Join in the fun ~ sign up & wear a festive costume or anything Green! Celebrate the St. Patrick’s Day holiday at Coaltown Taps after the race with live music - Let's ROCK! All proceeds and donations benefit St. Jude Children's Research Hospital.

Pre-registration:
(ends 2/28/21)
$25
$20 18 under
| Regular
| Registration:
$30
$25 18 under
Make checks payable to: Soles4Service, Inc.
Mail this form to: Soles4Service, Inc.
PO Box 284
Tazewell, VA 24651
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Charity Hurst, cdhurst17@gmail.com
5K Run/Walk
Male & Female Awards:

Overall (top 3)

Age Groups (top 3)
...14,15-19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60-64,65-69,70...
Virtual 5K
Male & Female Awards:



Age Groups (top 3)
No awards

ShamROCK'N 5K Run/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: 5K Run/Walk | Virtual 5K

*** 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)


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