REGISTRATION: 7:30- 8:30 am
START OF RACE: 9:00 am SHARP
RUN AGE DIVISIONS
MALE & FEMALE
12 & UNDER 30-39
13-15 40-49
16-19 50-59
20-24 60-69
25-29 70 & OVER
AWARDS
TOP THREE FINISHERS IN THE RUN AGE GROUPS WILL RECIEVE
AWARDS. AWARDS TO OVERALL MALE & FEMALE RUNNERS.
ALL PRE-REGISTERED RUNNERS & WALKERS WILL RECIEVE A
T-SHIRT. RACE DAY SHIRTS LIMITED. SNACKS AND DRINKS
WILL BE PROVIDED AT THE FINISH LINE.
MAIL ENTRIES TO: GASTON LIONSCLUB
P.O. BOX 513
GASTON, IN 47342
MAKE CHECKS PAYABLE TO: GASTON LIONS CLUB
FOR MORE INFORMATION CALL: GARY STRUBEN AT (765) 358-4576 OR LEAVE MESSAGE WITH
GASTON LIONS CLUB AT (765) 358-3032
GASTON LIONS CLUB 5K RUN/WALK
REGISTRATION (PLEASE PRINT)
NAME: ___________________________________________________________
ADDRESS: ________________________________________________________
CITY/STATE: _____________________________________________________
ZIP: ___________________________ PHONE: __________________________
AGE ON RACE DAY:________________ SEX: M______ F________
PLEASE CIRCLE
SHIRT SIZE: S M LG XLG XXLG
SELECT ONE: RUN WALK
PLEASE CHECK IF YOU NEED SHUTTLED TO GASTON _______
5K RUN 5K WALK
$15 BEFORE JULY 31 $12 BEFORE JULY 31
$17 DAY OF RACE $15 DAY OF RACE
I KNOW THAT PARTICIPATING IN A RUNNING /WALKING EVENT IS A POTENTIALLY HAZARDOUS
ACTIVITY. I SHOULD NOT ENTER UNLESS I'M MEDICALLY ABLE. I ASSUME ALL RISKS ASSOCIATED
WITH MY VOLUNTARY PARTICIPATION IN THIS EVENT, INCLUDING BUT NOT LIMITED TO FALL,
CONTACT WITH ANOTHER PERSON, THE EFFECTS OF THE WEATHER, TRAFFIC AND CONDITIONS
OF THE ROADS, ALL RISKS BEING KNOWN AND APPRECIATED BY ME. I AGREE TO ABIDE BY A
DECICION OF THE OFFICIALS RELATIVE TO MY ABILITY TO SAFELY COMPLETE THE RUN OR WALK.
KNOWING THE FACTS AND IN CONSIDERATION OF YOUR ACCEPTING MY ENTRY, I FOR MYSELF,
MY HEIRS, EXECUTORS, ADMINISTRATORS OR ANYONE ELSE THAT MIGHT CLAIM ON MY BEHALF
CONVENT NOT TO SUE AND WAIVE, RELEASE AND DISCHARGE GASTON LIONS CLUB, GASTON
POLICE DEPT., CARDINAL GREENWAY INC., ALL SPONSORS OF THE EVENT, AND THEIR REPRESENTATIVES
FOR ANY CLAIMS OR LIABILITY, WETHER FORSEEN OR UNFORSEEN FOR DEATH, PERSONAL
INJURY, OR PROPERTY DAMAGE ARISING OUT OF, OR IN THE COURCE OF MY PARTICIPATION IN THIS
EVENT.
SIGNATURE OF PARTICIPANT
________________________________________________________________
SIGNATURE OF PARENT OR GUARDIAN IF UNDER 18 YAERS OF AGE
_________________________________________________________________
(THIS FORM MAY BE COPIED)
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