Don't Stop Believing 10K & 5K


The Richlands Railway Section Foreman's House
1542 Front Street
Richlands, VA 24641, Richlands, VA

7/29/2023


8:00 a.m. 10K & 5K

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.

Don't Stop Believing 10K & 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 EVENT: Don't Stop Believing 10K | Don't Stop Believing 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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