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Mantachie Gold Ribbon 5k Fun Run/Walk Benefitting St. Jude Children's Research Hospital SATURDAY, SEPTEMBER 21, 2013 Sign-In Begins at 7:00 a.m. Run/Walk Begins at 8:00 a.m. Line-Up will be in front of Mantachie High School Gym Race ENTRY FEES: Before August 31 st * After August 31 st 5k Run/Walk $20.00 $25.00 You can Register online at www.racesonline.com * All Participants Who Pre-Register Will Receive a Race/Walk T-Shirt (Shirts not guaranteed for Race Day registrants) TOP RUNNERS IN EACH AGE DIVISION WILL RECEIVE PRIZE Name Age DOB M F Address Phone Email Address Emergency Contact T-Shirt Size (Circle One): AS AM AL AXL YM YL Team (Circle One): Team Sam (Sam Farris) Team Jace (Jace Counce) Team Audrey (Audrey Burleson) Team Jake (Jake Cooley) Team Daniel (Daniel Turner) Team Haley Grace (Haley Grace Mathis) Team Caroline (Caroline Vanasselberg) Team Mallory (Mallory Scott Berger) Team Jorden (Jorden Daniel) Team Bo (Bo Carter) www.racesonline.com or MAIL FORM and CHECK TO: Mantachie Gold Ribbon 5k - P.O. Box 100 - Mantachie, MS 38855 For More Information Call: 791-1228 WAIVER (Must Sign): In consideration of acceptance of this entry, I waive any and all claims for myself and my heirs against the officials or the sponsors of the Mantachie Gold Ribbon 5k and Fun Run/Walk for injury or illness which may directly or indirectly result from my participation in this event. SIGNATURE DATE (Parent if under 18 years of age)

Mantachie Gold Ribbon 5k Fun Run/Walk - 9.21.2013 - Mantachie, MS

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Mantachie Gold Ribbon 5k Fun Run/Walk Benefitting St. Jude Children's Research Hospital

SATURDAY, SEPTEMBER 21, 2013

Sign-In Begins at 7:00 a.m. Run/Walk Begins at 8:00 a.m.

Line-Up will be in front of Mantachie High School Gym

Race ENTRY FEES: Before August 31st * After August 31st 5k Run/Walk $20.00 $25.00

You can Register online at www.racesonline.com

* All Participants Who Pre-Register Will Receive a Race/Walk T-Shirt (Shirts not guaranteed for Race Day registrants)

TOP RUNNERS IN EACH AGE DIVISION WILL RECEIVE PRIZE

Name Age DOB M F

Address

Phone Email Address

Emergency Contact

T-Shirt Size (Circle One): AS AM AL AXL YM YL

Team (Circle One):

Team Sam (Sam Farris) Team Jace (Jace Counce)

Team Audrey (Audrey Burleson) Team Jake (Jake Cooley)

Team Daniel (Daniel Turner) Team Haley Grace (Haley Grace Mathis)

Team Caroline (Caroline Vanasselberg) Team Mallory (Mallory Scott Berger)

Team Jorden (Jorden Daniel) Team Bo (Bo Carter)

www.racesonline.com or MAIL FORM and CHECK TO: Mantachie Gold Ribbon 5k - P.O. Box 100 - Mantachie, MS 38855

For More Information Call: 791-1228 WAIVER (Must Sign): In consideration of acceptance of this entry, I waive any and all claims for myself and my heirs against the officials or the sponsors of the Mantachie Gold Ribbon 5k and Fun Run/Walk for injury or illness which may directly or indirectly result from my participation in this event. SIGNATURE DATE (Parent if under 18 years of age)