Betsy Smith 5k_signup_2009

Fourth Annual BETSY SMITH MEMORIAL 5K RUN/WALK SATURDAY, September 26th, 2009 8:00AM @ ST. MARY’S HOSPITAL 1800 E. LAKE SHORE DRIVE Decatur, IL 62521 Betsy Smith, daughter of Dr. Dan and Jeanie Smith entered into the presence of Jesus on Wednesday, April 26th, 2006. Betsy dedicated her life to serving the Lord through inner city mission work in Marion, Indiana. All proceeds from this event will go to further Betsy’s passion with 1/3 to Realife Ministries, Marion, Indiana , 1/3 to CASA and 1/3 to Good Samaritan Inn, Decatur, Illinois.

HEB 12:1

“And let us run with perseverance the race marked out for us.”

Course:

Run/walk start and finish at St. Mary’s Hospital

Entry Fee:

$15.00 on or before September 5th $20.00 after September 5th

Check-in:

Check in time race day is 7:00-7:45am at St. Mary’s Hospital

Awards:

First three places in each division & overall male & female winners will receive awards. Walkers will receive ribbons. There will be door prizes.

T-Shirts:

Each pre-registered runner/walker will receive a complimentary t-shirt. All other runner/walkers will receive a shirt while supplies last.

Send entry fee to: Betsy Smith 5k Run/Walk c/o Theresa Miller 2546 S Baltimore Ave Decatur IL, 62521 Make checks payable to: Betsy Smith 5k Run/Walk

For additional information please contact: Theresa Miller @ (217) 620-2555 / [email protected] -----------------------------------------------------------------------------------------------------------------------------------------OFFICIAL ENTRY FORM & WAIVER Please circle one:

Name:

_________________________________

Address: _________________________________ City:

_______________ St.___ Zip:________

Phone:

_________________________________

WAIVER: In consideration of my entry, I for myself, my executors, administrators and assigns, do hereby release and discharge The Decatur Park District, City of Decatur, and St. Mary’s Hospital and all Race sponsors, workers, directors and officers for any injuries suffered by me at this event. I certify that I have trained for a race of this distance and weather conditions, and I am physically fit for the race entered.

Signature ______________________________________ (Parent or Guardian for Consent if Entrant is under 18)

Age Division 10 & under 11 – 14 15 – 19 20 – 24 25 – 29 30 – 34 35 – 39 40 – 44 45 – 49 50 – 54 55 – 59 60 – 64 65 – 69 70+

Sex Male Female Event 5K Run 5K Walk T-Shirt Size Adult / Youth Small ____ ____ Med ____ ____ Large ____ ____ XL ____ XXL ____

Email ____________________________________ (Include email address to receive race information via the web)

Dr. Carol A. Cunningham Dr. Tom and Mary Davey Associated Otolaryngologists of Decatur

Dr. Tim and Shelly Bailey & Family