Track Backers 09

Mt. Zion’s 7th Annual Gettin' on Track 5K Run/Walk th Saturday, November 14 2009 at 9:00am Register online again this year at www.getmeregistered.com Entry Fee: $12 by November 7th - No shirt only $8 Late registration $15 - No shirt $11 1 mile fun run is FREE (t-shirt not included) Registration: Early registration is recommended and Race day registration will start at 7:30 a.m. Awards: Top three finishers in each age group, overall winners, and overall masters (40+) winners T-shirts guaranteed to all pre-registered applicants. Drawing for donated prizes Food & drinks at the finish line. Check in and parking at Mt. Zion High School (305 S. Henderson Street). ---Sorry no refunds For further information contact: Kelly Fox 705 Eric Ct Mt. Zion, IL 62549 [email protected]

SPONSORS-___ The Back Institute Nike Whiplashhh Energy Drink Dansig Insurance- Jim Smith Kenney’s Ace Hardware Geisler Law Offices State Farm Insurance- Susan Vermette

The Law Office of Steven W. Perbix Sunshine Motors Mt. Zion Recreation Dept. Dr. Tim Bailey Temmen Advanced Eye Care Brinkoetter-Kevin Fritzche

--------------------------------------------------------------------------------------------------------- --Registration Form (please print) Age Divisions: Circle one: Circle one Men or Women Name: __________________________________ 11 and under 35-39

Address: ________________________________

City: ___________________________________

12-13

40-44

Shirt Size:

14-16

45-49

S M L XL

17-19

50-54

20-29

54-59

Race:

30-34

60+

Run or walk

State: ___________ Zip ___________________ Phone: __________________________________

Checks payable to: Mt. Zion Trackbackers

Waiver: Please read carefully and sign. In consideration of my entry, I, intending to be legally bound for myself, my heirs, executors and administrators, waive, release and forever discharge any and all right and claims which I may hereafter accrue to me against the Mt. Zion Trackbackers, Mt. Zion CUSD, staff, volunteers or any of its promoters for any and all injuries suffered by me at this event. I further warrant that I have trained for the race of this distance and am physically fit for such a race. Signature: _________________________________________________ If under 18 years of age, parent or guardian Mail to:

Mt. Zion Jr. High School Gettin’ on Track 315 S. Henderson Street Mt Zion, IL 62549