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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)