Benefitting Choices Pregnancy Resource Clinic

A RACE TO SAVE LIVES

Saturday. November 9. 2013 BONA DEA TRAILS. RUSSELLVILLE, AR

RACE BEGINS @ 9 a.m. $20 Pre-Registration that GUARANTEES your t-shirt ends September 30 th ! child strollers welcome October 1 st 23 rd : Registration is $25. October 24 th Race Day: Registration is $30.

5K Run/WALK, Family 1K, & Virtual Participants

Last Name:______________________________ First Name:___________________________________ Gender (Circle One): MALE FEMALE Birthdate:_________________________ Age on 11.9.13:________________ Address:_________________________________________ Email:_____________________________ Shirt Sizing Info: All participants registered by September 30th are guaranteed a shirt Late/day of race registrants may receive a shirt while supplies last! Adult: (circle one): S M L XL XXL Youth (circle one): X/S (2/4) S (6/8) M (10/12) L (14/16) Event (circle one): 5K RUN @ 9 a.m. 5K WALK @ 9:05 a.m. FAMILY 1K (following 5K) VIRTUAL 5K PARTICIPANT ** Registration and Check-In will begin at 8 a.m. and end at 8:45 a.m.** Event Fees: All participants/virtual participants registered by Sept. 30 th are guaranteed a shirt! Children (12 & Under): Pre-Register by Sept. 30th: $10 Oct. 1st 23rd: $15 Oct. 24th Nov. 9th: $20 Teens/Adults (13 & up): Pre-Register by Sept. 30th: $20 Oct. 1st 23rd: $25 Oct. 24th Nov. 9th: $30 Virtual Participants: Pre-Register by Sept; 30th: $20 * virtual donations after this date are not guaranteed a shirt.
Release:
I know that running/walking and volunteering to work in races are potentially hazardous activities. I should not enter and run/walk this race 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/walk. I assume all risks associated with running/walking and volunteering to work races including, but not limited to, falls; contact with other participants; the effect 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 Catch the Beat 5K, Choices Pregnancy Resource Clinic, Bona Dea Trail, city of Russellville, ArkansasRunner.com, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in the event, even though that 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.

City:________________________ State:_________ Zip:____________ Phone:_______________________

Signature:______________________________________________________ Date:_______________ Parent Signature (if under 18): _____________________________________ Date:_______________

Please make checks payable to Choices Pregnancy Resource Clinic, P.O. Box 394 Russellville, AR 72811 For electronic payment, please fill out the form below and return by mail, with registration. I request my bank or credit card company to make a ONE-TIME transfer of $____________. Bank Draft Information Debit/Credit Card Information

Checking (Attach a voided check) Savings (Attach a voided deposit ticket)

VISA

MasterCard

Debit Card

Acct # ___________________ Exp. Date ______/______

Date _______________________ Signature ___________________________________________ Please send me newsletters via e-mail address: _______________________________________

Choices PRC P.O. Box 394 Russellville, AR 72811 479.967.2255 (office) 479.498.4554 (fax) choicesprc.org Benefitting Choices Pregnancy Resource Clinic

A RACE TO SAVE LIVES

Saturday. November 9. 2013 BONA DEA TRAILS. RUSSELLVILLE, AR

5K Run/WALK, Family 1K, & Virtual Participants
RACE BEGINS @ 9 a.m. child strollers welcome

Date, Times, Location:

Saturday, November 9, 2013 Bona Dea Trail, Russellville, AR 5K Run/Walk starts at 9 AM, 1K Family Run/Walk immediately following

Entry Fees:

By September 30 th October 1 st-23 rd October 24 th-Race Day

$15 $25 $20 $20 $30 $20

Children (12 and under): $10 Teens/Adults (13 and over): $20 Virtual Participants: $20

Registration: Early Registration (through September 30 th) guarantees a t-shirt Late Registration (after September 30 th) may receive a t-shirt as long as supplies last

Refreshments:

Online: www.choicesprc.org/events.html (A processing fee will be charged through raceroster.com for credit cards) By Mail: Send completed form w/payment to: Choices Pregnancy Resource Clinic, Inc. P.O. Box 394 Russellville, AR 72811 In Person: Choices PRC office, 311 E. 3rd St. Russellville AR, 72801 Office Hours: Monday 2-7 PM Tuesday 10-3 PM Thursday 10-5 PM Race Day: Registration will be available the day of the race at Bona Dea Trails in Russellville, AR from 8 AM 8:45 AM Water and other refreshments will be provided during and after the run

Inclement Weather Policy:

The race will go on regardless of precipitation. In the event that weather conditions present an imminent danger to participants, the race will be cancelled. No refunds will be given.

Choices PRC P.O. Box 394 Russellville, AR 72811 479.967.2255 (office) 479.498.4554 (fax) choicesprc.org