7/29/2019 Fcc Run.2013.Entry Form

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rsEnnud Run . o o Fof Heaven's Sakg*sil# socKs 2o1s'lOx, 5x, lxSerunney, AFRtt t1 zots AT 8:So A.I[.@ Flnsr CrnrsrrArf Cuuncr, FmRe, Inrvors

I5r mn lr lilnurns W:rcorrrHlProceeds will help send 5o high school students to a "CIY" (christ In Youth) event this summer in Cleveland, TI{.PruRncrsrnauoN/Rrcrsrna.rroN Frn:If entry forms received on or before April 2: 10K & 5K: $20 1K: $5 .No shirt provided for lKIf entry forms received after April 2: 10K&5K: $25 1K: $5Same Day Registration AvailableFINAL registration @ First Christian Church @ 7:00 AM the day of the race and closes at 8:15 AMA11 events begin at 8:30 AM outside the First Christian Church; courses close at i0:30 A.M.Those pre-registered on or before April 2 for the 10K and 5K events are assured of receiving a short-sleeveMoisture Management T-shirt. Extra shirts will be ordered but will be available only while supplies last tothose registered after April 2. 'lK Participants may order a cotton t-shirt (please add $5.00) on or before April 2.EVENT: AGE CATErcnv (CmCrr ONr):10K 18 &under, 19-24, 25-34; 35-44; 45-54; 55 & older5K 11 & under; 12-15; 16-18; 19-24; 25-34; 35-44; 45-54; 55 & olderlKFunRun AllFunRgn Parricipants uJill receive aRibbonPTEASE CIRCLE YoUR T-SHIRT sIzE. IF NoT MARKED, YoU TLL RECETVE e MToTuu.Youru slzr: Srmn }frorur Lencr

Apu[T srzE: Srnlr lt{rorur LARGE X-lancu *XXL *m $zNAMEADDRf,SS CTTy STATE ZTP EMAIL ADDRESS ,, AGE oN DATE oT RUN GENDERWaiverl By signing below, I do hereby release and discharge from liability the First Christian Church and the City of Flora,organizers, event sponsors, suprvisors of the '$illY SOCKSRID 2013' and thdir representatives, succssors and assigns for anyand all causes of action, cliaims, and injuries suffered by me in this event, however incurred. I attest and verifu that I havesufffciently trained for the completion of this event. As a parent or guardian of the applicant (if applicant under ttre age of 1 8),I hereby consent to the participation of the applicant in the race under the above mentioned conditions.Signature----- - Date--------

MAKE CHECKS PAYABLI o: FCC RUNMArL ENTRy FoRM To: Fmsr CnRrsrnu CuuncR, Arr: FCC RUN, 100 W. 4"', FLoRA, lL 62839OrHER CoNrACr rNFoRMArroN: www.fccflora.com oR CA]-L (618) 508-2755 oR FACEBooK PAGE: RIIN . . . FOR HEAVEN'S SAKE