Cross Country Challenge 5K Walk/Run to benefit the “Wounded

Cross Country Challenge
5K Walk/Run
to benefit the
“Wounded Warrior
Project”
DATE: May 2, 2015
TIME: 8:00 a.m.
Registration begins at 7:00 a.m.
LOCATION: Clyde Austin 4H Camp
214 4-H Lane Greeneville, TN
(located next to Link Hills Golf Course/Country Club)
ENTRY FEES:
$20.00 Pre-Registration
$25.00 After April 17, 2015
Shirts only guaranteed to pre-registered runners!
Checks made payable to Laughlin Memorial Hospital.
NO REFUNDS.
****100% of all proceeds go to the Wounded Warrior Project****
AGE CATEGORIES: Overall Winner Male & Female Winner; and 2 deep
for each age group: 12 & under, 13-16, 17-25; 26-35; 36-45; 46-55; 5665; 66 & up
If you would like to purchase a t-shirt ONLY (not participate in the run),
please complete the form below and check the appropriate box. Shirts
will be available the day of the run.
Please fill out registration form & return to:
Laughlin Memorial Hospital
Tracy Green
1420 Tusculum Blvd. Greeneville, TN 37745
Ph#423-787-5097
COURSE: The challenge goes through the
grounds of the 4H campus. It is a beautiful
run around the lake, around the perimeter of
the campus and through farmland. This is
strictly a cross country event. This is not a
certified course.
PRE-REGISTRATION FORMS DUE BY APRIL 17, 2015
T-shirts guaranteed for pre-registered participants only!
Last Name_______________ First Name_______________________ M.I.____ Sex_____ Age (on Race day): _______
T-Shirt Size (circle one): XS / S / M / L / XL / XXL / XXXL
Please indicate if you ONLY want a t-shirt and are NOT entering the run/walk : t-shirt only______________
Address__________________________________________________________City_______________State_____Zip__________
Email Address _______________________________________
Home Phone____________________________
Work Phone__________________
Cell Phone______________________
Emergency Contact_________________________ Relationship________________ Phone Number_________________________
WAIVER: I certify that I am in good physical condition and understand the risk involved in my participation in this run. I hereby release and hold harmless the Clyde
Austin 4H camp, Laughlin Memorial Hospital, and any others associated with this event; whether directly or indirectly for all liability as to any right of action that
may occur to either the undersigned or his or her personal representative for any injury, loss of life, or damage to property. To assure the safety of all participants,
unregistered runners, strollers, unauthorized vehicles, bicycles, skateboards, rollerblades, roller skates, and dogs are strictly prohibited from the course during the
event.
Signature of Competitor ______________________________________ Date____________________
Signature of Parent (if under 18) ________________________________Date____________________