Burkettsville 5k Form
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7th Annual
Burkett 5K Run/Walk Saturday, August 8, 2009 at 8:30 am Burkettsville Community Picnic, Burkettsville, OH RACE LOCATION AND TIMES
Starts and ends at Burkettsville Park Pre-Registration post marked by July 25, 2009 Race day registration 7:00 am – 8:15 am National Anthem 8:25 am
ENTRY FEE
$13 Day of race - includes shirt - limited supply $10 Pre-registered - includes shirt $10 Day of race - without shirt $7 Pre-registered - without shirt $7 Shirt only - no race Make checks payable and mail entries by July 25, 2009 to: The Burkett 5K, P.O. 14, Burkettsville, OH 45310
RESULTS
Enclose SASE or visit www.mercerhealth5kchallenge.com or www.anna5k.com
AWARDS
Plaques for the top 3 male overall, top 3 female overall Medals for the top 3 in each age category Mercer County 5K Challenge - Ceremony
DOOR PRIZES
All door prizes donated by generous sponsors. MUST BE PRESENT TO WIN.
AGE GROUPS
10 - under 11 - 14 15 - 19
RACE DIRECTORS
Joe and Vicky Barga
20 - 24 25 - 29 30 - 34
35 - 39 40 - 44 45 - 49
50 - 55 Men only 56 - 61 Men only 62 and over Female only 56 and over
PROCEEDS GO TO BURKETTSVILLE COMMUNITY PARK ----------------------------------------------------------------CUT ALONG DOTTED LINE-------------------------------------------------------ENTRY FORM AND WAIVER OF LIABILITY MUST BE SIGNED TO PARTICIPATE THE BURKETT 5K RUN/WALK -- AUGUST 8, 2009
AGE AS OF AUGUST 8, 2009 ______ BIRTHDATE ____/____/_____ SEX: MALE or FEMALE
SHIRT SIZE (please circle) ADULT S M L XL XXL YOUTH M L AMOUNT ENCLOSED: __________________
NAME ________________________________________ PHONE NUMBER ________________________ ADDRESS _____________________________________ E-MAIL _________________________________ CITY__________________________________________ STATE ______ ZIP ______________________ In consideration of the acceptance of my entry, I, for myself, my executors, administrators, and assignees, do hereby release and discharge THE BURKETT 5K and any other sponsors and officials for all claims of damages, demands, or actions, whatsoever in any matter arriving or growing out of my participation is said athletic event. _______________________________________________________________________________________________________________________ _______________________________ PARTICIPANT SIGNATURE AND PARENT/GUARDIAN IF UNDER AGE 18 DATE
Burkett 5K Run/Walk Saturday, August 8, 2009 at 8:30 am Burkettsville Community Picnic, Burkettsville, OH RACE LOCATION AND TIMES
Starts and ends at Burkettsville Park Pre-Registration post marked by July 25, 2009 Race day registration 7:00 am – 8:15 am National Anthem 8:25 am
ENTRY FEE
$13 Day of race - includes shirt - limited supply $10 Pre-registered - includes shirt $10 Day of race - without shirt $7 Pre-registered - without shirt $7 Shirt only - no race Make checks payable and mail entries by July 25, 2009 to: The Burkett 5K, P.O. 14, Burkettsville, OH 45310
RESULTS
Enclose SASE or visit www.mercerhealth5kchallenge.com or www.anna5k.com
AWARDS
Plaques for the top 3 male overall, top 3 female overall Medals for the top 3 in each age category Mercer County 5K Challenge - Ceremony
DOOR PRIZES
All door prizes donated by generous sponsors. MUST BE PRESENT TO WIN.
AGE GROUPS
10 - under 11 - 14 15 - 19
RACE DIRECTORS
Joe and Vicky Barga
20 - 24 25 - 29 30 - 34
35 - 39 40 - 44 45 - 49
50 - 55 Men only 56 - 61 Men only 62 and over Female only 56 and over
PROCEEDS GO TO BURKETTSVILLE COMMUNITY PARK ----------------------------------------------------------------CUT ALONG DOTTED LINE-------------------------------------------------------ENTRY FORM AND WAIVER OF LIABILITY MUST BE SIGNED TO PARTICIPATE THE BURKETT 5K RUN/WALK -- AUGUST 8, 2009
AGE AS OF AUGUST 8, 2009 ______ BIRTHDATE ____/____/_____ SEX: MALE or FEMALE
SHIRT SIZE (please circle) ADULT S M L XL XXL YOUTH M L AMOUNT ENCLOSED: __________________
NAME ________________________________________ PHONE NUMBER ________________________ ADDRESS _____________________________________ E-MAIL _________________________________ CITY__________________________________________ STATE ______ ZIP ______________________ In consideration of the acceptance of my entry, I, for myself, my executors, administrators, and assignees, do hereby release and discharge THE BURKETT 5K and any other sponsors and officials for all claims of damages, demands, or actions, whatsoever in any matter arriving or growing out of my participation is said athletic event. _______________________________________________________________________________________________________________________ _______________________________ PARTICIPANT SIGNATURE AND PARENT/GUARDIAN IF UNDER AGE 18 DATE
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