5K Run/Walk - Sussex Lions Club

164
Good Hope Rd.
Silver Spring Rd.
Sussex Village Park
74
Lisbon Rd.
K
45
I run the Village!
Capitol Rd.
190
16
F
To Madison
164
94
To Milwaukee
Printing compliments of
5K Run/Walk
Saturday, July 12th, 2014
8:30 am
Sussex, WI
Place
Stamp
Here
Entry Form
Participant Gift
___________________________________________________________________________
Participant’s Full Name (please print)
Each person will be rewarded for their participation with a
Tank top to commemorate their effort in helping to raise money
for the recreation scholarship fund.
___________________________________________________________________________
Address
“I Run The Village”
5K Run/Walk
___________________________________________________________________________
City, State, Zip
________ Birthdate
___________ Male/Female
(
)_______________________
Phone Number
Saturday, July 12th, 2014
Sussex, WI
___________________________________________________________________________
E-Mail Address
Tank top size: Youth Adult
Small Med
Fees
Lg
Register by July 1st
$20 individual
$40 Family*
Register after July 1st
$24 individual
$48 Family*
XL XXL XXXL
The 5K course will be run through residential neighborhoods in
Sussex. The race will begin and end in Sussex Village Park and
is a timed event.
*Separate entry forms required for each family member.
Photocopies of form accepted. All family forms must be
submitted in one mailing.
__________________________________________________________________________
Name of Corporate Team
Start time: 8:30 am
5K run/walk starts at 8:30 am in Sussex Village Park.
Enter Village Park off Main Street on Weaver Drive.
Registration
Waiver
I know running in a race is a potentially hazardous activity. I should not enter and run
unless I am medically able and properly trained. I agree to abide by a decision of a race
official relative to my ability to safely complete the run. I assume all risks associated
with running in the event including but not limited to falls, contact with other participants,
the effects of weather including high heat and/or humidity, traffic and conditions of
the road, all such risks being known and appreciated by me. Having read this waiver
and knowing these facts and in consideration of your accepting my entry, I for myself
and anyone entitled to act on my behalf, waive and release the Village of Sussex,
race officials, all sponsors, their representatives and successors from all claims and
liabilities of any kind arising out of participation by me or any of my minor children in this
event. I grant permission of all the foregoing to use any photographs, motion pictures,
recordings or any other record of this event for any legitimate purpose. I certify I am an
amateur and eligible to compete in this event.
Participant Signature
Date
__________________________________________________________________________
Parents Signature (if under 18)
Date
Award Ceremony
Gift certificates from InStep running store will be awarded
to the top male and female finishers.
Medals will be awarded to the top 3 male and female finishers
in each age group.
The awards ceremony will be held near the finish line
immediately following the run/walk.
Proceeds
$15 individual
__________________________________________________________________________
Participant gifts cannot be guaranteed for entries received
after July 1st, 2014
Online registration now available at
www.villagesussex.org
or
Send entry form and appropriate fee to:
Sussex Parks & Recreation Dept.
W240 N5765 Maple Avenue
Sussex, WI 53089
Make checks payable to the Village of Sussex.
Entry fee is non-refundable and must be included with entry
form. Photocopies of the entry form are allowed. Entry forms
are available online at www.villagesussex.org
Pre-registration packet and same day
registration available from 7:30am – 8:15am
the day of the race
Proceeds from this event will go to the recreation scholarship
fund. The scholarship fund was established to support children
participation in recreational activities so that no child is
excluded from recreational opportunities because of
financial limitations.
For the safety and enjoyment of all participants, pets will not be
allowed on the course or in Sussex Village Park during the run.
For further information, please contact Megan Sackett at
[email protected]