ESA 5K Fun Run

Sat., June 28th, 8:00 am

Starts at Ball Diamond

South-side (across the river)

Registration & warm-up

7:00am - 7:45am

Download Word Document Form

Download in PDF Format

AWARDS

All entrants shall receive

an official 5K t-shirt (adult sizes)

Plaques awarded to top overall

male and female 5K runners

Medals awarded to top finishers

in each age category:

(15-U, 16-19, 20-29, 30-39, 40-49, 50-59, 60-Over)

____________________

$20 before June 17 / $25 after June 17

Make checks payable to ESA Alpha Chi

____________________

Send Application form and entry fee to:

ESA Alpha Chi

47331 - Freedom Street

Dell Rapids, SD 57022

605-428-6032

For more information call:

Brenda O'Hara @ 428-6032 or

email brendaohara@siouxvalley.net

Fundraiser for Local Community Projects

APPLICATION FORM

Name

Address

City

State

Zip

Phone #

Age (on June 28)

Gender:

T-Shirt Size

I certify that I am in good health and have trained for this event. Inconsideration of your acceptance of this entry, I hereby, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against the organization holding this competition, their agents, representatives, successors, and assignors for any and all injuries by me at said competition.

By checking this box I submit my approval to this former statement.

By checking this box I, the undersigned parent or legal guardian of the competitor, hereby approve and confirm the above waiver and release.

Parent or Guardian Name

On-Line applications will be held

for receipt of entry fee.

Placement on the Race Roster is subject to receipt of payment.