DATE: Saturday, September 11, 2004

PLACE: South Jones High School Band Hall, Ellisville, Mississippi

TIME: 8:00 a.m. – 5K Run/Walk

COURSE: Slightly hilly

ENTRY FEE: $12.00 Pre-Registration $15.00 Day of Race

AWARDS:

· Guarantee of T-shirt on Race Day ONLY if application

is received by September 3

· Awards to Overall Male and Female, Masters Male and Female, Grand Masters Male and Female, and First Three Finishers in Each Age Category

AGE CATEGORIES:

Male: 13 to 18 40 to 44 Female: 13 to 18

19 to 24 45 to 49 19 to 24

25 to 29 50 to 54 25 to 29

30 to 34 55 to 59 30 to 34

35 to 39 60 to 64 35 to 39 65 and over 40 to 44 45 to 49 50 and over

RACE INFORMATION: Day – 477-4063 Cheryl Windham

Night – 425-3038

Night – 425-1389 Phillip Wedgeworth

The race course will start near the football field and finish in the parking lot at South Jones High School. Drinks, water, and fruit will be served in the Band Hall afterwards. Also, bathroom facilities are located in the Band Hall.

Early Registration Form

Mail to the following address: Jones County Junior College

c/o Cheryl Windham

Humanities Department

900 Court Street

Ellisville, Mississippi 39437

Name _________________________________________________ (Please Print)

5K Run _______ 5K Walk ______ (Check One)

Address __________________________ City _____________ State ______ Zip ______

Age __________ Birthday ______________ 19____ Sex F M (Circle One)

T-shirt Size (Circle One) Adult S M L XL

Amount of money enclosed $

Make check payable to South Jones Band Parent Association

IN CONSIDERATION OF YOUR ACCEPTING MY ENTRY, I, INTENDING TO BE LEGALLY BOUND FOR MYSELF, MY HEIRS, EXECUTORS AND ADMINISTRATORS, DO HEREBY RELEASE AND DISCHARGE SOUTH JONES HIGH SCHOOL, THE SOUTH JONES BAND, THE SOUTH JONES BAND/PARENT ASSOCIATION, THE CITY OF ELLISVILLE, AND ANY ALL SPONSORS OF THE RACE FROM ANY AND ALL LIABILITY ARISING FROM ILLNESS, DAMAGES AND DEATH THAT I MAY SUFFER AS A RESULT OF MY PARTICIPATION IN THESE EVENTS. I CERTIFY THAT I AM IN GOOD PHYSICAL CONDITION TO PARTICIPATE IN THE 5K RUN.

SIGNATURE ____________________________________________ Date __________

(Parent or Guardian MUST sign if applicant is under 18 years of age)

DIRECTIONS: Take the Ellisville Exit #88 from I-59 and head east toward the town of Ellisville. Look for the South Jones High School sign and turn LEFT to go to the school.

Thank you and we look forward to seeing you here!