present the

HUBfest Mississippi 5K State Championship Run / Walk

All proceeds benefit local children with Muscular Dystrophy.

Saturday, October 9, 2004

Kamper Park, Hattiesburg, Mississippi (near Pavilion)

Time :

5K Run / Walk begins at 8:00 a.m.

1 mile Run / Walk begins at 9:00 a.m.

Awards:

Ø Top 3 Male and Top 3 Female Walkers will receive recognition trophies for the 5K walk.

Ø 5K Run trophies will be presented to the Overall, Master & Grand Master finishers in both males and female categories. These trophies are crafted by local stained glass artist Tim Buckner.

Ø Commemorative coffee mugs will be awarded to top 3 Males and Females in 5-year age groups.

Ø Trophies will be presented to the first 3 male and 3 female finishers that are registered in the 1 mile run / walk.

Entry Fees:

Ø Pre-registration postmarked by October 1, 2003:

$15.00 all event categories

$12.00 Club Members & under 18

Ø Day of Race registration:

$20.00 all event categories

Ø $50.00 Families over 3 people

Tee Shirts:

Tee-shirts are only guaranteed on race day to those registered before October 1, 2004.

Mail Entries to:

Pine Belt Pacers, Attn: Keith Barrett,

641 River Road, Hattiesburg, MS 39401

HUBfest Mississippi 5K State
Championship Run / Walk

Registration

Name: _____________________________ Age on Race Day:_____ DOB:___/___/___

Address: ___________________________ Phone: (home) _______________________

City / State / Zip: _____________________________ (day time) ____________________

Sex (circle one) Male Female Tee-shirt size (circle one) S M L XL

Event (check one): ____5K Run ____5K Walk ____1 mile Run / Walk

School Represented:___________________

Waiver for the HUBfest 5K Run / Walk and 1 mile Fun Run / Walk

In consideration of the acceptance of this entry, I assume full and complete responsibility for any injury or accident which may occur while I am
traveling to or from the event, during the event, or while I am on the premises of the event. I am also aware of and assume all risks associated with
participating in this event, including but not limited to falls, contact with other participants, effect of weather, traffic, and conditions of the road. I,
for myself and heirs and executors, hereby waive, release and forever discharge the event organizers, sponsors, promoters, and each of their agents,
representatives, successors and assigns, and all other persons associated with the event, for all my liabilities, claims, actions, or damages that I may
have against them arising out of or in any way connected with my participation in this event. I understand that this waiver includes any claims,
whether caused by negligence, the action on inaction of any of the above parties, or otherwise.

I understand that the entry fee is non-refundable and non-transferable. I hereby grant full permission to any and all of the above parties to use any photographs, videotapes, motion pictures, web site images, recordings or any other record of this event.

Signature: __________________________ Date: ____/______/______

(Parent if under 18 years of age)