1ST Annual Paul B. Johnson State Park
5K Run/Walk and 1 mile Fun Run

July 8, 2006
1mile starts @ 8 am and 5k @ 8:15 am.
Sponsored by: Grace Chapel C.D.K.  js8cop@msn.com

Come and Take a Run by the Lake and enjoy a great swim and Food after the race.
Awards 1st , 2nd, 3rd Food and live music!!

1stAnnual Paul B. Johnson State Park 5k 10 miles south of
Hattiesburg on Highway 49.

Categories:
Top 3 in age group.
5k Male and Female 14 and under, 15-19, 20-30, 31-40, 41-50, 51-60, 61-and over.
1st and 2nd over all awards will be given for race walkers
1 mile 1st, 2nd, 3rd for 12 and under male and female

If you pre–reregister it will only be $10 if you pre register and $12 Day of race.
Group Rates and team discounts Available. Call for more details.

Checks payable to: Grace Chapel Baptist Church C.D.K.
2169 Highway 49
Brooklyn, MS 39425 All entry fees are non-refundable.

PLEASE PRINT CLEARLY: More Info: Contact Jay 601-408-5325

____________________________________ ________________________________ ____

Last Name First Name MI

____________________________________________________________________________

Street Address/Apartment Number

____________________________________________ _____ _________ _____ _____

City State Zip Code Sex M Sex F

______-______-________ ____ /____ /____ ____ Walker: _____ _____

Telephone Number Date of Birth Age Yes No

____________ Shirt ___ ___ ___ ___ ___ ___________________________________

Number S M L Xl XXL Email Address ___________________________________

I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly
Signature of Parent or Guardian if entrant is under 18. trained. I agree to abide by any decision of a race official
relative to my ability to safely complete the run. I assume all the risks associated with running in this event including but not limited to fall,
contact with other participants, the effects of weather, including high heat and/or humidity, traffic and other conditions of the road, all such risks
being known and appreciated by me. Having read this waiver and knowing these facts and in considerations of your accepting my entry, I, for
myself and anyone entitled to act on my behalf, waive and release the Grace Chapel Baptist Church C.D.K. and all sponsors, their
representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. I grant permission to all of the
forgoing to use any photographs, motion pictures, recordings or any other record of this event for any legitimate purpose.

Signature Date

________________________________________________________ __________________