D - Choices Pregnancy Resource Clinic, Inc.

BENEFITTING: CHOICES PREGNANCY RESOURCE CLINIC
SATURDAY, NOVEMBER 7, 2015
BONA DEA TRAILS, RUSSELLVILLE, AR
5K RUN/WALK, FAMILY 1K, VIRTUAL PARTICIPANTS
RACE BEGINS @ 3 P.M.
DATE, TIMES, LOCATION:
Saturday, November 7, 2015
Bona Dea Trail, Russellville, AR
1K Family Run/Walk starts at 2 P.M., 5K Run/Walk starts at 3 P.M. ENTRY FEES:
BY SEPTEMBER 1ST
Children (12 and under):
Teens/Adults (13 and over):
Virtual Participants:
$10
$20
$20
SEPT 2ND –OCT. 1ST
OCT 2ND - RACE DAY
$15
$25
$20
$20
$30
$20
REGISTRATION: Registration (through October 1st) guarantees a t-shirt
Late Registration (after October 1st) may receive a t-shirt as long as supplies last
Online: raceroster.com/6165 or www.choicesprc.org/events.html
(A minimal processing fee will be charged through raceroster.com for credit cards)
By Mail: Send completed form with payment to:
o Choices Pregnancy Resource Clinic, Inc.
P.O. Box 394
Russellville, AR 72811
rd
In Person: Choices PRC office, 311 E. 3 St. Russellville, AR 72801
Office Hours: Monday-Thursday 9 A.M. – 5 P.M.
Race Day: Registration will be available the day of the race at Bona Dea Trails in Russellville, AR
Kids Superhero 1K Fun Run registration will begin at 1:15 P.M.
5K Run/Walk registration will begin at 2:15 P.M.
REFRESHMENTS:
Water and other refreshments will be provided during and after the race
INCLEMENT WEATHER POLICY:
The race will go on regardless of precipitation. In the event that weather conditions present an imminent danger to
participants, the race will be cancelled. No refunds will be given.
Choices PRC – P.O. Box 394 – Russellville, AR 72811 – 479.967.2255 – choicesprc.org BENEFITTING: CHOICES PREGNANCY RESOURCE CLINIC
SATURDAY, NOVEMBER 7, 2015
BONA DEA TRAILS, RUSSELLVILLE, AR
5K RUN/WALK, FAMILY 1K, VIRTUAL PARTICIPANTS
RACE BEGINS @ 3 P.M.
Pre-Registration that GUARANTEES your t-shirt ends October 1st!
$20 Early Registration until September 1, $25 Registration September 2nd-October 1st, $30 Registration October 2nd-Race Day
Name: ______________________________________ First Name:______________________________________________ Last Gender (Circle One): MALE FEMALE Birthdate:_______________________ Age on 11.1.14______________ Address:___________________________________________________ Email:____________________________________________ City:___________________________ State:_______________ Zip:________________ Phone:________________________ Shirt Sizing Info: All participants registered by October 1st are guaranteed a shirt – Late/day of race registrants may receive a shirt while supplies last! ADULT (Circle one): S M L XL XXL YOUTH (circle one): X/S(2/4) S(6/8) M(10/12)
EVENT (Circle one): 5K RUN
5K Walk
FAMILY 1K (following 5K)
L(14/16)
VIRTUAL 5K PARTICIPANT
Registration and Check-in will begin at 2:15 P.M. and end at 2:45 P.M.
Event Fees: All participants/virtual participants registered by October 1st are guaranteed a shirt! Children (12 & Under): Pre-­‐Register by Sept. 1st: $10 Teens/Adults (13 & up) Pre-­‐Register by Sept. 1st: $20 Virtual Participants: Pre-­‐Register by Sept. 1st: $20 Sept. 2nd – Oct. 1st $15 Oct. 2nd – Nov. 7th $20 Sept. 2nd – Oct. 1st $25 Oct. 2nd – Nov. 7th $30 Release: I know that running/walking and volunteering to work in races are potentially hazardous activities. I should not enter and run/walk this race unless I am medical able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run/walk. I assume all risks associated with running/walking and volunteering to work races including, but not limited to falls; contact with other participants; the effect of the weather, including high heat and/or humidity; the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the C atch the Beat 5K, Choices Pregnancy Resource C linic, Bona Dea Trail, City of Russellville, ArkansasRunner.com, and all sponsors, their representatives and successors from all claims or liabilities of anything arising out of my participation in the event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose. SIGNATURE:_______________________________________________________________________________ DATE:____________________________ PARENT SIGNATURE (IF UNDER 18) ___________________________________________________ DATE: ____________________________ Please make checks payable to Choices Pregnancy Resource Clinic, P.O. Box 394 Russellville, AR 72811 * For electronic payment, please fill out the form below and return by mail, with registration. ☐I request my bank or credit card company to make a ONE-­‐TIME transfer of $_____________________. ☐Checking (Attach a voided check) | ☐ Visa ☐MasterCard ☐ Debit Card ☐ Please send me newsletters via email address: _________________________________________________ Choices PRC – P.O. Box 394 – Russellville, AR 72811 – 479.967.2255 – choicesprc.org