Printable Application

398 S. Shell Road * DeBary, FL 32713
Saturday, May 30, 2015 at 7:30am
MAIL TO FINAL MILE RACE MANAGEMENT
2578 ENTERPRISE RD. #169, ORANGE CITY FL 32763
CHECKS PAYABLE TO FINAL MILE RACE MANAGEMENT
MAILED ENTRIES MUST BE POSTMARKED BY 5/23/15 OR REGISTER ONLINE AT
DeBary5k.com
CUSTOM FINISHER’S MEDALS TO ALL PARTICIPANTS!
PLEASE PRINT LEGIBLY
NAME_________________________________________________________________________________________________________________
ADDRESS___________________________________________________________________________TEL_______________________________
CITY___________________________________________________________________STATE______________ ZIP_______________________
5K____
SEX:
M
F
AGE_______ BIRTHDATE (mm/dd/yyyy)_____/_____/_________ ENCLOSED $_______________________
Entry fees are nonrefundable. Credit cards accepted during online registration only. Cash or Check only accepted on race day.
SHIRT SIZE:
Moisture Wicking Tech Shirt included. Sizes are not guaranteed for late registration after May 18th
Youth S (___) Youth M (___) Youth L (__)
Adult S(__) M(__) L(__) XL (__) 2X (__)
EMAIL ADDRESS_______________________________________________________________________________________________________
Incomplete or unsigned Entry Forms will not be accepted. In consideration of my entry being accepted, I Intend to be legally bound and do hereby for myself, my heirs, executors, waive and release all rights and claims for
damages which may have or which may hereinafter accrue to me against DBK Construction, Kruid Charitable Foundation, DeBary Elementary, Final Mile Race Management, LLC, the Road Runners Club of America , The
City of DeBary, the County of Volusia, the race sponsors, any subsidiary or political division thereof, of their respective officers, agents, directors, representatives, successors, assigns, and sponsors for any and all damages or
injuries which may be sustained and suffered by me in connection with my association with entry or participation in the event as is mentioned above. I know that participating in this event is a potentially hazardous activity. I
should not enter unless I am medically able and properly trained. I agree to abide by any decisions of a race official relative to my ability to safely complete. I assume all risks associated with participating in this event
including but not limited to, falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. I am
aware that the foregoing organizations assume no liability in the event of cancellation of this event for any reason and that the entry fees are not refundable. Further, I grant permission to all the foregoing to use my name and
images of myself in any photographs, motion pictures, results, publications or any other print, videographic or electronic record of this event for legitimate purposes. If I should suffer injury or illness I authorize officials of
the race to use their discretion to have me transported to a medical facility, and I take full responsibility for this action, I attest and certify that I am physically fit and have sufficiently trained for the completion of this event. I
hereby grant full permission to any and all of the foregoing to use any photographs, videotapes, motion pictures, recordings or any other record of this event for any purpose. Bicycles, baby strollers/joggers, dogs, inline/roller
skates, are prohibited. I have read the above release and understand that I am entering this event at my own risk.
Signature______________________________________________________________________Date_________________________
Parent if race participant is under the age of 18
RACE ENTRY FEES
Through March 29th $20
March 30 – April 5 $25
April 6 – Race Day $30
Students 17 & under
$15.00 through April 5th
$20.00 after April 5th
FREE KIDS RUN
8:20 a.m.
All kids receive a winning ribbon
LOCATION
DBK Construction
398 S. Shell Road
DeBary, FL 32713
DeBary5k.com
RACE PARTY WITH FAMILY ACTIVITIES
Bounce House & Face painter
Free Adult Beverages
Beverages and Snacks for the Kids
TIMING & SCORING
Professionally chip timed
Registered runners will receive a chip race morning
AWARDS Ceremony at 8:30 a.m.
Top Overall Male & Female;
Top Overall Male & Female Masters.
Top 3 in Age Groups 9 & under; 10-14,
15-24, 25-29, 30-34, 35-39, 40-44, 45-49,
50-54, 55-59, 60-64, 65-69, 70-74, 75+