| Pre-registration: (ends 9/27/2023) |
$20 - 5K Run, $12 - 1-Mile Fun Walk | | Regular | Registration: |
$25 - 5K Run, $12 - 1-Mile Fun Walk | |
| Make checks payable to: UVA Wise | ||||
| Mail this form to: The University of Virginia's College at Wise, Gilliam Center for the Arts, 1 College Avenue, Wise, VA 24293 | ||||
| Trophy for Overall Female and Overall Male Winners; Medals for Top 3 Winners in each age division. Only preregistered individuals are guaranteed a t-shirt. Registration form is available on the Run for the Arts 5K website provided as well. |
| Headphones are permitted on the course | Strollers are NOT permitted on the course |
| For more info contact Jessica Necessary, jjn5y@uvawise.edu ; (276) 328-0256 | Run for the Arts 5K Male & Female Awards: Overall (top 3) Masters (top 3) GrandMasters (top 3) Sen.GrMasters (top 3) Age Groups (top 3) 10-19; 20-29; 30-39; 40-49; 50-59; 60+ |
| 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 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. STROLLERS ARE NOT ALLOWED ON THE RACE COURSE. |
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SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |