A part of the “Taking Strides Towards Better Health” Grand Prix series
FAITH, FAMILY & FRIENDS 5K
2nd Annual Race In Loving Memory of our beloved – Debbie Ferbrache
Saturday, May 11, 2013 @ 9:00 am
Zion Christian Retreat & Nature Center
(73999 Reservoir Hill Road, Flushing OH 43977)
THE COURSE: The 5K trail will be an on & off the road, through the woods and around the lake.
“Proud to be part of Ohio Valley Trail Running Series 2013”
RACE PROCEEDS BENEFIT: East Richland Christian School
Top 3 Male and Female Overall Run & Walk Categories
RUN AND WALK Awards – Top 3 Male/Female in following age groups:
10 & under, 11-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70+
******* All ERCS students who participate will be eligible for a FREE Dress Down Day! *******
RACE DAY REGISTRATION: 7:45 – 8:45 am the1st 200 race entrants will receive a SPECIAL gift.
www.zionchristianretreat.org - www.eastrichland.org
www.grandprix.healthplan.org - www.theracedeal.com
Mail entries & checks made payable to: Lori Smolira (on check memo please reference “FF&F5K”), 39333 Co. Rd. 72, Flushing, OH 43977. Questions and/or directions: Contact Lori at 740.827.3862 or email . ***************************************************************************************************************************************************
Name: ______DOB: ______Age on Race Day: ______
Address, City/State Zip: ______
Phone: ______E-mail: ______Male ___ Female ___ Runner ___ Walker ___
FEES: Early Entry $15 _____ After April 26, 2013 $20 ______Family Rate: ______ERCS Student Rate: ______
Special Discounts (4+ immediate family members $50 max. due) // ERCS Student Fee: $10
Additional Donation: ______
Waiver: By signing below, you agree, warrant and covenant as follows: In submitting this entry, I, intending to be legally bound for myself, my heirs, executors and administrations, waive, release and forever discharge any and all rights and claims which I may hereafter accrue against the ERCS, Zion Christian Retreat and Nature Center, any event sponsors, race directors, event volunteers, event staff, and their officers, directors, agents, successors and/or assigns for any injuries suffered by me at this event while traveling to and from the event or while participating in it. I attest and verify that I am physically fit and sufficiently trained for the competition of this event. I understand that I may be photographed and agree to allowing my photo, video, or film likeness to be used for legitimate purpose by the aforementioned parties. Please sign below to indicate that you have read and agree.
SIGNATURE ______SIGNATURE DATE ______
(parent's signature if under 18 years old)