36th Annual Great Duck Race Registration Form

Great Duck Race
Sponsored by Baptist Health
Saturday l November 28, 2015
10k - 8:00 a.m. 5k - 8:15 a.m.
Course Information
Race Start Time
v 5K or 10K Race
v Very flat and fast course!
v Aid stations provided at miles 2 and 4
v Refreshments for participants following
race
v FREE official moisture wicking Duck
Race tee shirt!
v The Great Duck Race will use chip timing technology to calculate results. Participants must wear a race chip to get an official race time.
The 10k race will start at 8:00 a.m. in front
of the bank with the 5k to follow at 8:15 a.m.
The finish line is also in front of the bank.
How to Pre-Register
Complete the entry form and include the
appropriate entry fee. Make checks payable to Stuttgart Chamber of Commerce.
Mail to: Stuttgart Chamber of Commerce,
P.O. Box 1500, Stuttgart, AR 72160.
Entry Fees
Paid before October 31st..........$25.00
Paid after October 31st..............$30.00
Note: If early registration is mailed, it must be postmarked on or before October 31, 2015. We cannot guarantee an Official Duck Race moisture
wicking t-shirt for registrants after October 31st.
Virtual Runners will receive an official Duck Race moisture wicking t-shirt and race packet by mail.
Packet Pickup
REGISTRATION FORM
Mail this completed form with a $25 check before
October 31, 2015 ($30 after). Make check payable to Stuttgart Chamber of Commerce and mail to:
Stuttgart Chamber of Commerce
P.O. Box 1500
Stuttgart, AR 72160
Race packets may be picked up from 6:30
a.m. – 7:30 a.m. on race day inside the
Farmers & Merchants Bank located at 708
South Main Street, Stuttgart.
Race Entered:
Late Registration
____________________________________
Full Name
Late registration is from 6:30 a.m. to 7:30
a.m. on race day inside bank. Note: Registration will end promptly at 7:30 a.m.
Awards and Prizes for each race
Winners receive a Duck Race medal!
l Overall Male and Female 1st place
winners in 10k receive watches from
Wilkerson Jewelers
l Overall Male and Female 1st place
winners in 5k receive duck calls from
RNT Calls
l Masters Male and Female – 3 places
l Age Division – 3 places
l
Age Divisions (Male and Female)
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
70-74
75+
q 5K Duck Run
q 10K Duck Race
q Virtual Runner
____________________________________
Address
____________________________________
City, State, Zip
Gender ____ Birthdate ________ Age _____
Telephone ___________________________
Shirt Size (circle one)
S
M
L
XL
Please Read Disclosure and Sign
In signing this form for myself (or if under 18 years of age, by my parent
of legal guardian), I understand and agree to absolve and hold harmless the sponsors and officials of the Great Duck Race and Arkansas
Runner of all blame for any injury, harm, loss or inconvenience that
may directly or indirectly result from my participation in said event.
I further state that I am in proper physical condition to participate in
this event. I also understand and agree that my entry fee is non-refundable. I understand that I will be removed from the race if officials
deem necessary for my safety. By entering, I agree that my name
or likeness can be published or broadcast without compensation.
Signature____________________________
BULK RATE
U.S. Postage
PAID
Stuttgart, AR
Permit No. 1
Sponsored by:
GREAT DUCK RACE
5K & 35th Annual 10K
Saturday l November 28, 2015
STUTTGART
MEDICAL CLINIC
507 S. Main
l
P.O. Box 1500 l Stuttgart AR 72160
(870) 673-1602
Stuttgart Chamber of Commerce
P.O. Box 1500
Stuttgart, AR 72160
Stuttgart, Arkansas
Please remit to:
Stuttgart Chamber of Commerce
P.O. Box 1500
Stuttgart, AR 72160
(870) 673-1602
[email protected]