Thursday, November 23,2006
Lake Serene Club House, (Hwy 98 West to the West Lake Serene entrance)
Time : 5 Mile Run / Walk begins at 8:00 a.m. Kids Fun Run at 9:15 a.m.
Awards: Top 3 male and female 5M Walkers will receive trophies. 5M Run trophies will be presented to the Overall, Master & Grand Master finishers in both males and female categories. Trophies will be awarded to top 2 Males and Females in 10-year age groups.
Mail Entries to: Pine Belt Pacers, Attn: Dawn Smith, 353 Emerson Dr., Hattiesburg, MS 39401
Entry Fees:
Pre-registration postmarked by November 19, 2006:
$18.00 all event categories $15.00 Club Members
Day of Race registration:
$20.00 all event categories
$10.00 no Tee-shirt option $45.00 Families over 3 people
No charge for the Kids Fun Run
Tee Shirts: Tee-shirts are only guaranteed on race day to those registered before November 19, 2006
Make checks payable to: Pine Belt Pacers
Hobble then Gobble 5 Mile Run / Walk
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): ____5M Run ____5M Walk email address: ____________________________
_ Check to receive emails about other upcoming events.
Waiver for the Hobble then Gobble 5M 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)