Monster Mash Bash 5K


Town Hall, Pound, VA, Pound, VA

10/29/2022


October 29, 2022 at 7pm

| Regular
| Registration:
Pre-registration can be mailed or filled out by stopping by Town Hall
Make checks payable to: Town of Pound
Mail this form to: Town of Pound
Monster Mash Bash 5K
PO Box 880
Pound, VA 24279
Handcrafted medals for all winners by local artist.
$25 per runner or $100 for a group of 5 runners.
Event t-shirt guaranteed to first 30 to register.
Costume may be worn but not required.
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Leabern Kennedy
leabernkennedytop@gmail.com
276-393-3119
Monster Mash Bash 5K
Male & Female Awards:

Overall (top 3)
Top Masters
Top GrandMasters
Top Sen.GrMasters

Age Groups (top 3)
...15,16-25,26-35,36-45,46-55,56-65,65...

Monster Mash Bash 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)_________________________________________

TEAM NAME____________________________

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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