| Pre-registration: (ends 4/1/2023) |
Early Bird through 2/28: 5K $25, 1 Mile $15 Fee through 4/1: 5K $30, 1 Mile $20 | | Regular | Registration: |
After 4/1: 5K $40, 1 Mile $23 | |
| Make checks payable to: Reynolds Memorial United Methodist Church | ||||
| Mail this form to: Reynolds Memorial United Methodist Church 1320 Mary Street Bristol VA 24201 | ||||
| T-shirts guaranteed thru April 1 |
| Headphones are NOT permitted on the course | Strollers are permitted on the course |
| For more info contact Robert Kariuki, kariukirob@yahoo.com | Ken-Ya Run It? 5K Male & Female Awards: Overall (top 3) Top Masters Top GrandMasters Age Groups (top 3) 10 under, 11- 14, 15-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70 over | 1 Mile Walk (Untimed) Male & Female Awards: Age Groups (top 3) No awards |
| 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: Ken-Ya Run It? 5K | 1 Mile Walk (Untimed) |
*** 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. PARTICPANTS USING HEADPHONES ARE NOT ALLOWED ON THE RACE COURSE. |
|
SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |