8/22/2019 2013 5K Registration Form

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REGISTRATION

**This Waiver Must Be Signed **

5K Run 5K Walk 1 Mile Fun Run

AGE (As of 10/12/13) REQUIRED:_______________Gender: Female Male

Name ________________________________________

Address ______________________________________

City ______________________State _______________

Zip ____________ Phone ( ) ___________________

E-Mail ________________________________________

5K RunTeam/Company Name (5 People Minimum)NAME:_______________________________

T-shirt Size: S M L XL

WAIVERMust be Signed

In consideration of the acceptance of my entry, my executors, administrators,and assignees do hereby release and discharge the 5K Race Committee,sponsors, organizers, the town of Chatham, their officials and members of allclaims and damages, demand and action w hatsoever in any manner incurred bymy participation in the 5K Race, 5K Walk, 1 Mile Events on October 22, 2011. Iattest and verify that I have full knowledge of the risks involved in this event and Iam physically fit and sufficiently trained to participate in the event, I also releasethe use of my name or any record of my participation in this event for promotionalor publicity purposes without remuneration or obligation to me.

Signature______________________________________Date______________

Parent/Guardian Signature_________________________________________

(Parent /Guardian Signature needed if under 18)

Pre-registration fee - $20.00 ($25.00 after Sept. 20th)Make check payable to: Chatham 5K RaceMail Check and this entry form to:Race Registration Questions?

c/o Paul Nicholson paul@wepresentyou.com702 S. Main Street (434) 489-9480Chatham, Virginia 24531

INFORMATION

Registration Procedures:Pre-registration fee is $20.00 and must be received bySeptember 20th (no refunds).Your cancelled check willbe your receipt. After September 20th the fee will be$25.00. There will be race day registration from 7:30 a.m.to 8:45 a.m., near the start-finish. Registration forms maybe machine copied. We reserve the right to reject any

entry.Certification: The 5K course has beenTAC certified to national standards: VA98028RT

Liquids & Refreshments:Available at thestart/finish line and two points along the course.

T-shirt:Guaranteed for the first 300 Pre-registeredrunner and walkers.

Course Records (Open 5K)Jimmy Ball- 16:38 (M) Allison Peters- 19:24 (F)

AWARDS & PRIZES

Race awards & door prizes will be announced

And distributed following the 5K race

$250 Cash Prize to any Male or Femalebreaking the course record!

$100 Cash Prize for the Best Costume onRace Day (open to all participants and judgedby our panel after the race).

Trophies/Ribbons to Age Group Winners inmultiple categories.

See You On October 12th!

RACE DAY DETAILS

DIRECTIONS:The Town of Chatham, Virginia is located on Hwy 29

between Lynchburg and Danville, Virginia. From the

West, take Route 57 East which leads to Main Street; turn

North. From the East, take Route 58 West or 360 South toRoute 29 North or take Route 57 West which leads to

Main Street. From 29 North & South take the Chatham

29 Business exit.

STARTING TIMES ON OCT 12th:

Race Day Registration: 7:30 a.m. 8:45 a.m.Pre-Reg. Packet Pickup: 7:30 a.m. 8:45 a.m.

1 Mile Fun Run / Walk: 9:00 a.m.5K Run and 5K Walk: 9:30 a.m.Participants meet at the corner of Main Street and Center

Street for all events. Events will run, rain or shine.

PARKINGAvailable at the

Pittsylvania CountyCourthouse/Sheriffs

Department ParkingLot and Main Street

STARTINGTIMES

1MileFun Run/Walk

9:00 a.m.

5K Run Walk9:30 a.m.

Participantsmeet at Main &Center Streets