| Pre-registration: (ends 7/15/2022) |
10K Through July 14 - $30 5K Through July 14 - $25 | | Regular | Registration: |
10K July 15-July 29 - $35 5K July 15 - July 29 - $30 | |
| Make checks payable to: Soles4Service, Inc. | ||||
| Mail this form to: PO Box 285 Tazewell, VA 24651 | ||||
| 10K Trophies 5K No Trophies *T-shirts are guaranteed to pre-registered runners only. |
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact Charity Hurst cdhurst17@gmail.com 276-970-1887 | Don't Stop Believing 10K 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... | Don't Stop Believing 5K Male & Female Awards: Top Overall No age group trophies for the 5K, finisher's medallions to all runners. |
| 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: Don't Stop Believing 10K | Don't Stop Believing 5K |
*** CIRCLE SHIRT SIZE: SM, MD, LG, XL, XXL |
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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) |