$30 includes TSHIRT

& Drink Ticket

SupportingFauquier Sports Foundation &

HCCA Family Relief Fund

Register at runsignup.com/race/VA/Manassas/ditchdiggersdash

9AM | S u n d ay

S e p t . 1 3 , 2020

2S i l o s B r ew i n g C o .

Ditch

Diggers

Dash

5th Annual

BENEFIT 5K

Race Day Information: September 13, 2020 | 1 Mile Fun Run begins at 9:00 am | 5K begins at 9:30 am 2Silos Brewing Co. – 9925 Discovery Blvd. Manassas, VA 20109 Awards & Raffles following Race

Race Day Registration: 8:00 am – 9:00 am. Runners must be present at 9:00am because Discovery Blvd closes for Fun Run Strollers and pets (bring dog bags) are welcome at rear of the 5K.

Online: https://runsignup.com/Race/VA/Manassas/DitchDiggersDashEmail: events@hcca.net or Fax to 703-392-7249 Mail: send completed form to each runner below & check made out to HCCA: 9251 Industrial Ct, Suite 201, Manassas VA 20109

How To Register:

5th ANNUAL HCCA DITCH DIGGERS DASH 5K RUN/WALK REGISTRATION FORM (All Information & Signatures Required)

Name: ________________________________________________________________________________________________

Address: _______________________________________________________ City/State/Zip:____________________________

Phone: _____________________________________ Email: ____________________________________________________

Birth Date: _______/______/________ Age on Race Day: ________ Sex: Male Female

HCCA Member Firm (if applicable): _________________________________________________________________________

T-Shirt Size: ADULT Small Medium Large XL 2XL 3XL CHILD YSmall YMedium YLarge

Emergency Contact: ___________________________________________ Phone: ___________________________________

5K Registration Fee: Early $30.00 (on/prior to (8/15/20) Late $35.00 (after 8/15/20) Child $15.00 (12yrs. or younger)

1 Mile Fun Run Registration Fee: Child $10.00 (12 yrs. or younger) In consideration of you accepting this entry, I, the participant, intending to be legally bound do hereby waive and forever release any and all right and claims for damages or injuries that I may have against HCCA, RunSignup.com, Fauquier Sports Foundation and all of their agents assisting with the event, sponsors and their representatives, volunteers and employees for any and all injuries to me or my personal property. This release includes all injuries and/or damages suffered by me before, during or after the event. I recognize, intend and understand that this release is binding on my heirs, executors, administrators, or assignees. I grant permission to HCCA, Runsignup.com, and Fauquier Sports Foundation to use my name, voice and images of myself in any photographs, motion pictures, results, publications or any other print, videographic or electronic

recording of this event for legitimate purposes.

Signature:_____________________________________________________________ Date: _______/_________/_________ (*signature of parent or guardian is required if participant is under 18 years of age)

Invoice HCCA Member Firm listed above

HCCA 5TH ANNUAL DITCH DIGGERS DASH 5K SPONSORSHIP Join HCCA Member Firms & HCCA Health & Wellness Committee in supporting

Fauquier Sports Foundation & HCCA Family Relief Fund $500 Sponsorship included company logo on event banner and 5K Race T-Shirt

Company Name: ______________________________________________________________ Company Address: ________________________________________________________________________________

Contact Name: ________________________________________ Phone:_____________________________________ Email:___________________________________________________________________________________________

Please email your logo and completed information above to events@hcca.net

Benefitting: