2nd Annual“Gracee's Message of Hope5 K run and 1 mile walk”

Winfield City Park Winfield, AL

Saturday June 13th 7-7:30 Registration7:30am Start 1 mile8:00am Start 5 K

Prizes awarded to top 3 in each age divisionTrophy to overall Female and Male

Registration for 1mile fun run/walk $15.00 5 K participants $25.00T-shirts to the first 75 registrantsAll proceeds from this years race will be going for research on JHD.

Make checks or donations payable to Gracee Young. 10500 Co Rd 21 N Winfield, AL 35594

06/13/2015 PLEASE PRINT LEGIBLY

Name_____________________________________________ Sex____Age______ Address ____________________________________________________________ City, State Zip ________________________________________________________ Phone ___________________________ E-mail ___________________________ SHIRT SIZE (circle One) SM M L XL NONEName of affiliation of Club or Team _______________________________________

Waiver (MUST BE SIGNED)In consideration of your accepting this entry,I, the below signed, intending to be legally bound, for myself, my heirs,my executors and administrators, waive and release and any all rights and claims for damages I may have against the race, and sponsors and their representatives, successors and assigns for any and all injuries suffered by me in said event. I attest that I will participate in this event as a footrace, that I am physically fit and sufficiently trained for the completion of this event. Furthermore, I hereby grant full permission to use my name and likeliness, as well as any photographs and any record of this event in which I may appear for any legitimate purpose, including advertising and promotion.

Signature_________________________________________Date________

Parent or Guardian if under 18_____________________________________