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$30 includes TSHIRT
& Drink Ticket
SupportingFauquier Sports Foundation &
HCCA Family Relief Fund
Register at runsignup.com/race/VA/Manassas/ditchdiggersdash
9AM | S u n d ay
S e p t . 1 3 , 2020
2S i l o s B r ew i n g C o .
Ditch
Diggers
Dash
5th Annual
BENEFIT 5K
Race Day Information: September 13, 2020 | 1 Mile Fun Run begins at 9:00 am | 5K begins at 9:30 am 2Silos Brewing Co. – 9925 Discovery Blvd. Manassas, VA 20109 Awards & Raffles following Race
Race Day Registration: 8:00 am – 9:00 am. Runners must be present at 9:00am because Discovery Blvd closes for Fun Run Strollers and pets (bring dog bags) are welcome at rear of the 5K.
Online: https://runsignup.com/Race/VA/Manassas/DitchDiggersDashEmail: [email protected] or Fax to 703-392-7249 Mail: send completed form to each runner below & check made out to HCCA: 9251 Industrial Ct, Suite 201, Manassas VA 20109
How To Register:
5th ANNUAL HCCA DITCH DIGGERS DASH 5K RUN/WALK REGISTRATION FORM (All Information & Signatures Required)
Name: ________________________________________________________________________________________________
Address: _______________________________________________________ City/State/Zip:____________________________
Phone: _____________________________________ Email: ____________________________________________________
Birth Date: _______/______/________ Age on Race Day: ________ Sex: Male Female
HCCA Member Firm (if applicable): _________________________________________________________________________
T-Shirt Size: ADULT Small Medium Large XL 2XL 3XL CHILD YSmall YMedium YLarge
Emergency Contact: ___________________________________________ Phone: ___________________________________
5K Registration Fee: Early $30.00 (on/prior to (8/15/20) Late $35.00 (after 8/15/20) Child $15.00 (12yrs. or younger)
1 Mile Fun Run Registration Fee: Child $10.00 (12 yrs. or younger) In consideration of you accepting this entry, I, the participant, intending to be legally bound do hereby waive and forever release any and all right and claims for damages or injuries that I may have against HCCA, RunSignup.com, Fauquier Sports Foundation and all of their agents assisting with the event, sponsors and their representatives, volunteers and employees for any and all injuries to me or my personal property. This release includes all injuries and/or damages suffered by me before, during or after the event. I recognize, intend and understand that this release is binding on my heirs, executors, administrators, or assignees. I grant permission to HCCA, Runsignup.com, and Fauquier Sports Foundation to use my name, voice and images of myself in any photographs, motion pictures, results, publications or any other print, videographic or electronic
recording of this event for legitimate purposes.
Signature:_____________________________________________________________ Date: _______/_________/_________ (*signature of parent or guardian is required if participant is under 18 years of age)
Invoice HCCA Member Firm listed above
HCCA 5TH ANNUAL DITCH DIGGERS DASH 5K SPONSORSHIP Join HCCA Member Firms & HCCA Health & Wellness Committee in supporting
Fauquier Sports Foundation & HCCA Family Relief Fund $500 Sponsorship included company logo on event banner and 5K Race T-Shirt
Company Name: ______________________________________________________________ Company Address: ________________________________________________________________________________
Contact Name: ________________________________________ Phone:_____________________________________ Email:___________________________________________________________________________________________
Please email your logo and completed information above to [email protected]
Benefitting: