SPECIAL RACE FORM FOR W C R C Grand Prix Members
14th ANNUAL “Randall’s” RUN AND WALK FOR THE GYM 5K”
JULY 09, 2016 6:15 PM (5K)
“GOLD SPONSOR”
Sign up by June 30th Mail in entry only
Cash Awards: 5K 1st & 2nd Male & Female
Awards (Top 3 in 5 yr. age groups) (including 90+)
Start time: Kid’s Fun Run 5:30 pm Age 9 and Under “Fun Run Free
5K Run & Walk: Start Time: 6:15 pm
Entry Fee: $15.00 Pre: $25.00 Post T-Shirts: 1st 150
60+ $10.00 Pre: $25.00 Post Post Race Raffles
Student $10.00 Pre: $15.00 Post Park At: Nasson Common 457 Main St
Make Check Payable to: Nasson Community Center
Mail to: “Run for the Gym” 723 Hanson Ridge Rd, Springvale, ME 04083
Web Sites: http:/www.nassoncommunitycenter.com Information: BOB (207) 459-8376 or runbob@metrocast.net
First Name______________________________Last Name__________________________________Age: ___ M___ F _
Address: _______________________________________________________ ___________ DOB M--- D---- Y----
City:________________________ State.___Zip______Phone__________ T Shirt (circle) S- M – L – XL
E-Mail_______________
Check One: Run__ Walk_ ___WCRC MEMBER_______
Check if applicable: Sanford/Springvale Resident __
In signing this entry, I for myself, my executors, and administrators, release the manager of the race, The Nasson Center Redevelopment, and all sponsors and promoters from any and all liability and damages in case of death or injury received in or any way associated with this race.
Signature: (Guardian if under 18)_____________________________________Date: ________________