present the
HUBfest
All proceeds benefit local children with Muscular Dystrophy.
Saturday, October 8, 2005
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Time
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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 custom trophies will be presented to the Overall, Master & Grand Master finishers in both males and female categories. 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 September 23, 2005: $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 September 23, 2005. Mail Entries to: Pine Belt Pacers, Attn: Keith Barrett,
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HUBfest
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) |