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    Burkettsville 5K Form

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    grandlake1
    7th Annual Burkett 5K Run/Walk Saturday, August 8, 2009 at 8:30 am Burkettsville Community Picnic, Burkettsville, OH

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    Burkettsville 5K Form

    Uploaded by

    grandlake1
    113 views1 page
    7th Annual Burkett 5K Run/Walk Saturday, August 8, 2009 at 8:30 am Burkettsville Community Picnic, Burkettsville, OH

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    © Attribution Non-Commercial (BY-NC)

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    7th Annual Burkett 5K Run/Walk Saturday, August 8, 2009 at 8:30 am Burkettsville Community Picnic, Burkettsville, OH

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as RTF, PDF, TXT or read online from Scribd
    Download as rtf, pdf, or txt
    113 views1 page

    Burkettsville 5K Form

    Uploaded by

    grandlake1
    7th Annual Burkett 5K Run/Walk Saturday, August 8, 2009 at 8:30 am Burkettsville Community Picnic, Burkettsville, OH

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as RTF, PDF, TXT or read online from Scribd
    Download as rtf, pdf, or txt
    of 1

    7th Annual

    Burkett 5K
    Run/Walk
    Saturday, August 8, 2009 at 8:30 am
    Burkettsville Community Picnic, Burkettsville, OH
    RACE LOCATION Starts and ends at Burkettsville Park
    AND TIMES 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 20 - 24 35 - 39 50 - 55


    11 - 14 25 - 29 40 - 44 Men only 56 - 61
    15 - 19 30 - 34 45 - 49 Men only 62 and over
    Female only 56 and over
    RACE DIRECTORS Joe and Vicky Barga

    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 ______ SHIRT SIZE (please circle)


    BIRTHDATE ____/____/_____ ADULT S M L XL XXL YOUTH M L
    SEX: MALE or FEMALE 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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