PDF Form - Katty Race Shack



PDF Form - Katty Race Shack
2014 Supporters
Contribution Form
Please make check payable to: The Crime Victim Foundation/The KattyShack Race.
] Bronze $100-$199
] Silver $200-299
] Gold $300 & up
] Other _____________________
City _____________________ State __________
Zip ___________ Phone____________________
[ ] I give permission to have my name printed on
Foundation material under the category designated above.
[ ] I prefer that my name does not appear in print.
[ ] Please send more information on how I can
serve The Crime Victim Foundation.
The Crime Victim Foundation is operated by
volunteers and is funded entirely by charitable
contributions. 100% of foundation funds are
used to serve victims and the cause of victimsʼ
For more information please visit our website.
Peach Ridge Orchard Supply* Dr. & Mrs. Vasquez* Two Tonys Taverna Grille* Sweet Temptations* Ravenna Pattern* Mike & Beth
May* Nancy Pell* Ridge Builders* Stan's Bar* Phil & Dorothy
Brown* Pulver Chiropractic* Jan Brown & Alan Priest* Norma Umlor* Muskegon Lumberjacks* Beuschel Sales, Inc.* Knights of Columbus & Ladies Auxiliary* L&L Printing* Dick & Geri Grillo*
Stehouwer Frozen Foods* Buhler Prince* Jan Hood* Coles Bakery*
Morono Foods* Faye Umlor* The Runnery* Joni Luce/Mary Kay*
Don & Bonnie Messenger* Dunneback Fruit* Alpine Family Eyecare* Kraft* Ucellos* Home Depot* captured memories by ejk* BioFreeze* Redex* Blueberry Trails,LLC* Gazelle* Great Harvest
Bread Co.* Dr. Pepper/Snapple* Country Dreams 4-H Club* VanRegenmorter Family* St. Patrick's Family Center & Stephen Ministries,
Grand Haven* Betty Masko* Trinity Lutheran Church, Conklin*
Reister Grower Services, LLC* H&R Block* Gary & Becky
Wesley* LaFontaine Co.* Grip Trac, Inc.* Archers’ Acres* GH Garden House* Great Lakes Greek Chili Dogs *The Paper & Doll
Place* Ray's Drive-In* Michigan Rag CO.* Wendi Swenson* Bakers
Beads* Lew Russ & Co.* Erhart Family* Applebee's* Fortino's*
Hall Family Chiropractic* Holbrook Homes, LLC* Grand Haven
Eagles* Guitar Haven* Jazzercise* Grand Rapids Griffens* Lakeshore Dining Divas*Adecco* Cari Draft, Eco Trek Fitness* Village
Bike Shop* IT Resource* St. John’s Lutheran Church, Grand Haven*TriCities Transmission* DeLass Farm Market* Kelle Lynn*
Schwan’s* Family Fare* Culvers* Arturo’s* Wesco* Jimmy John’s*
Meijer* Lew Russ & Co.* Brooklyn Blanky Co.* Herb & Sharon
Reister* Hands to Health* Pam & Bill May* Ed & Darylene Pennington* John & Laura Lazet* Sheriff Rosema & Team* John &
Nancy Miller* Dave & Carol Kendrick* Mackite*Carla Hill* Starbucks* Jan V. * Grand Haven Days Inn* Ottawa County Prosecutor’s
Office* The Purple Rose* Roma Bishop* Bekins*Judy Mulder*Mary
Vanderwest*Linda Gay Olson*JoAnn Johnson*Kayla Lehman*
Cathy Langereis*Charlie Larnard*Jessica Reamsma*Kathi Waldecker*Sarah Bujak*Angela Bolt*Benjamin Champion*Mary
Mcgraw*Kate Krepps*Richard Tanis* Ottawa Friend of the Court
6th Annual
Katty Shack 5K Run/Walk
1 Mile Run/Walk
(And Pasta Dinner)
In Loving Memory of Katherine Brown,
Sharmaine, Jeremy and Tyler Zimmer
Forever in our hearts!
Friday /Saturday April 24 & 25, 2015
Grand Haven, Michigan
Katty Shack 5K & 1 Mile Run/Walk
All proceeds benefit The Crime Victim
Foundation of Michigan
Race Fees
•Until Jan. 31 - $20
•On Feb. 1 - $23
Family Rate: $18/person: for 3 or more at
same address
Late Registration (4/24 & 4/25) $27/person
Join us for the Fuel Up for
Katty Shack Pasta Dinner
donated by Two Tonys Taverna
Event Schedule (April 25, 2015)
•Packet Pick Up/Late Registration:
SATURDAY, April 25, 7:00-8:30 a.m.,
St. Johnʼs Lutheran Church, 527 Taylor Ave.
•Jazzercise: begins at 8:00 a.m.
•Pre-race Ceremony: 8:45 a.m.
•5K Run/Walk: 9:00 a.m.
•Both pre-race & start location: Near Mary A.
White School, 1400 Wisconsin Ave.
• 5K Course will have an aid station at half
way point
•1 Mile Run/Walk: Begins shortly after 5K start.
•Awards Ceremony, Door Prizes & Pancake
•Breakfast: St. Johnʼs Lutheran Church,
527 Taylor Ave.
•Raffle & Door Prizes
•Music w/ Lew Russ & Co.
•Tickets: ages 13 +, $9.00
ages 5-12, $6.00
under 5 eat for free
Mail-in registration
(post mark by April 20, 2015)
Name ____________________________ AGE:________
Date of Birth _________________
Gender: (circle one)
Race: (circle one)
1 Mile
Pasta Dinner(#.): ______$9.00 _____$6.00 _____under "
age 5
Address _______________________________________
City ___________________State______Zip___________
Phone ________________________________________
Contact Person _________________________________
E-mail Address __________________________________
Free Pancake Breakfast For All Participants
•The overall 5K male & female winners and male & female masters
will receive special awards and three deep in the following age
categories: 10 and under, 11-14,15-19, 20-24, 25-29, 30-34, 35-39,
40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70+
•Tickets pre-purchased via registration form or online
will be set aside at the door with familyʼs name.
Register on-line for Race and Pasta Dinner
Feel Free to photocopy for additional entries
Please PRINT clearly
Emergency Phone _______________________________
Thank you captured memories by ejk!
•Friday, April 24, 2015, 4:30-6:30 p.m.
•St. Patrickʼs Family Center, 920 Fulton St.,
Grand Haven , MI
•Dinner: spaghetti & meatballs/salad/bread/dessert/
Send entry form to:
NKB/KattyShack 5K, 2648 Gooding St., Conklin, MI 49403
Make Checks payable to: The KattyShack Race
For More information:
Contact Natalie Kik-Brown at [email protected] or
Joan Grillo at [email protected]
Check us out on Facebook!
Follow us on Twitter: @kattyshackrace
T-Shirt size: S
Youth M
XXL(Add $2)
Youth L
Legal Waiver & Signature: I know that running a road race is a potentially hazardous activity. I should not enter and run/walk unless I am
medically able and properly trained. I agree to abide by any decisions
of a race official to my ability to safely complete the run/walk. I assume all the risks associated with this event including, but not limited
to falls, contact with other participants, the effects of the weather,
traffic, and condition of the road. All such being known and appreciated by me. Having read the waiver I for myself and anyone entitled
to act on my behalf, waive and release the crime victim foundation,
their representatives, successors, sponsors and volunteers from all
claims and liabilities of any kind arising out of my participation in this
event. My photograph likeness or video may be used for any legal
purpose by race organizers. Organizers reserve the right to cancel
the race even in case of weather. No Refunds. I have read this
waiver and have agreed to its terms.
Signature of Applicant
(or parent/legal guardian if participant is under 18)
Date __________________

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