Friends and 5k Run/Walk
March 30, 2013
Ash Flat City Park
Last Name___________________________First Name___________________________
Date of Birth______________________Sex M_____F______ Age on Race day_______
Shirt Size: Circle One: Adult Small-
Adult Medium- Adult Large- Adult X-Large
You may walk, but there is only
a runners category for awards.
Pre-registration (mailed-in by March 24, 2013); $15.00
Day of Race registration (3:30pm -4:30pm): : $20.00
Make checks payable to: "Ash Flat Church of Christ" and send to: May Duhme, P.O. Box 654, Hardy, AR 72542
RACE RELEASE (Must be
signed by participant/parent or guardian)
I understand that my consent to these provisions is given in consideration of the acceptance of this registration and for being permitted to participate in this event. I am a voluntary participant in this event, and in good physical condition. I know that this is a potentially hazardous activity and I hereby assume full responsibility for any injury or accident which may occur during my participation in this event or while on the premises of this event. In consideration of acceptance of this entry, I waive and release any and all claims for myself and my heirs against the race organizers, the XXXXXXXX, MAC's Race Timing Service, the White River Roadrunners, and any and all sponsors of this race from any liability or any loss, damage, or injury which I may incur as a result of my participation in this race. I further state that I have trained and I am in proper physical condition to participate in this race. This entry is not valid unless signed by entrant. If entrant is under 18 years of age, parent or guardian must sign entry form.
Entry form not valid without signature and will be returned.
Parents must sign for children under 18. Must have one form per person with
signature. Photocopies are acceptable.
IPICO CHIP Instructions
1. All timed participants must pick up a timing chip race morning.
2. Timing chips must be affixed to your shoelace with a zip tie provided race morning.
3. Please do not swap timing chips with family or friends.
4. Results will be calculated by Chip Time.
5. Return your timing chip to a volunteer after you finish.
6. Please do not exit the finish chute with your race-day timing chip.
7. Participants will be charged $30 for timing chips not returned after the race.
8. Further instructions for timing chips will be announced on race day.