Miles For Missions 5K Run

and 1.5 Mile Family Fun Run/Walk

Entry Form
April 28, 2007 -- 8:00am – Pulaski Heights United Methodist Church  - Little Rock, AR

**Course Pending Certification – go to http://www.phumc.com/miles_for_missions.htm for course details**

 Last Name:                                                                 First Name:


 Date of Birth:                                  Sex:   M    F                              Age on 4/28/07:


 Address:


 City:                                                      State:                             Zip:

 

 I will participate in the:     5K Run       1.5 Mile Family Fun Run/Walk            5K Virtual Runner

      

 Please Circle One-

           Adult Shirt Size:       S       M        L       XL        XXL

          

           Child Shirt Size:       M        L          

                   

 Fees:
 5K Run and Virtual Runner–

               Pre-registration $20                          Race Day Registration:  $30

 1.5 Mile Family Fun Run/Walk (Maximum of $45/$60 per Family) – 

               Pre-registration $15                          Race Day Registration:  $20

 

 Make checks payable to Pulaski Heights United Methodist Church, write “Miles for Missions” in the check memo line and send to:

Miles for Missions
c/o Cindy Burns
4823 Woodlawn Avenue

Little Rock, Arkansas 72205

For more information, call  501-664-3600

 Release:
I know that running and volunteering to work in club races or training programs that are potentially hazardous activities. I should not enter and run in this race or training program unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run or training program. I assume all risks associated with running, participating in the training program, and volunteering to work in club races including, but not limited to falls, contact with other participants, the effects 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 your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Miles for Missions 5K, Pulaski Heights United Methodist, the city of Little Rock, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in the race, training program, and/or club activities even though 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:____________________

**Parents Signature required if under 18**

**For Office Use Only**

 Date Form Received: