YMCA

“BROOKSHIRE’S 5K CLASSIC”

Run/Walk & One Mile Fun Run

Saturday, November 13, 2004

Race Directed by: Mississippi Track Club

(Formerly known as the YMCA “Jitney Jog”)

We’ve changed the name, but the race is the same!

TIME: 8:30 a.m. (Registration and T-Shirt pick-up---7:15-8:15 a.m.)

LOCATION: Madison Avenue Elementary School off Old Canton Road Extension

COURSE: Both events begin and end at the school. The Fun Run will begin after the

5K race. The course is relatively flat with aid stations and mile splits.

AMENITIES: 100% Cotton Long-sleeved shirt guaranteed to all pre-registered participants.

Door Prizes and Refreshments! Awards go to overall and age group winners.

ENTRY FEE: Preregistration for each 5K event is $15.00. The One Mile Fun Run is $10.00.

Entries must be postmarked by Monday, November 8, or dropped off by Thursday, November 11, to the I-55 YMCA, 800 East River Place, Jackson, MS 39202.

Race Day Registration--$18.00 per person, per event. The Fun Run is $10.00.

5K RUN: Overall male and female winners, Master(40+), Grand Master(50+), as well

as Top 3 in the following age groups: 10 & under, 11-14, 15-19, 20-24,

25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70+

Wheelchair Division—Top 3 overall male and female

5K WALK: Overall male and female winners, Master(40+), Grand Master(50+), as well

as Top 3 in the following age groups: 19 & under, 20-29, 30-39, 40-49,

50-59, 60-69, 70+

ONE MILE: (Limited to 15 years and under) Ribbons to all participants. Overall male

and female as well as Top 3 in these age groups: 0-5, 6-7, 8-9, 10-12,

13-15. .

REGISTRATION FORM (Please print legibly)

CIRCLE ONE: 5K RUN 5K WALK ONE MILE FUN RUN

NAME_________________________________________________AGE:SEX:

ADDRESS________________________________CITY:______________ST:________ZIP:__________

PHONE: (HOME)___________________________(WORK)____________________________

T-SHIRT SIZE (ADULT SIZES) CIRCLE ONE: Youth L S M L XL XXL (ADD $2.00)

NAME OF SCHOOL IF PARTICIPATING IN FUN RUN-_____________________________________________

I hereby certify that I am adequately fit to run in this race. In consideration or the acceptance of this entry, I, the undersigned, for myself, my personal representative, beneficiaries, and heirs, knowingly waive, release, and discharge any and all rights and claims which I have or may have hereafter accrue to me or my estate against the YMCA of Metro Jackson, the Race Directors, any sponsors, MS. Track Club and assigns for any and all injuries or death suffered by me in this event. I will allow my picture to be used in publications as a result of this race.

SIGNATURE_______________________________________________DATE:_______________________