INFORMATION REGISTRATION

**This Waiver Must Be Signed ** 5K Run 5K Walk 1 Mile Fun Run

See You On October 12th!

Registration Procedures:
Pre-registration fee is $20.00 and must be received by September 20th (no refunds).Your cancelled check will be your receipt. After September 20th the fee will be $25.00. There will be race day registration from 7:30 a.m. to 8:45 a.m., near the start-finish. Registration forms may be machine copied. We reserve the right to reject any entry. Certification: The 5K course has been TAC certified to national standards: VA98028RT

AGE (As of 10/12/13) REQUIRED: _______________ Gender: Female Male

Name ________________________________________ Address ______________________________________ City ______________________State _______________ Zip ____________ Phone ( ) ___________________ E-Mail ________________________________________

Liquids & Refreshments: Available at the

start/finish line and two points along the course. T-shirt: Guaranteed for the first 300 Pre-registered runner and walkers.

STARTING TIMES

5K Run Team/Company Name (5 People Minimum) NAME:_______________________________ T-shirt Size: S M L XL

Course Records (Open 5K)

Jimmy Ball- 16:38 (M) Allison Peters- 19:24 (F)

PARKING
Available at the Pittsylvania County Courthouse/Sheriffs Department Parking Lot and Main Street

WAIVER
Must be Signed
In consideration of the acceptance of my entry, my executors, administrators, and assignees do hereby release and discharge the 5K Race Committee, sponsors, organizers, the town of Chatham, their officials and members of all claims and damages, demand and action whatsoever in any manner incurred by my participation in the 5K Race, 5K Walk, 1 Mile Events on October 22, 2011. I attest and verify that I have full knowledge of the risks involved in this event and I am physically fit and sufficiently trained to participate in the event, I also release the use of my name or any record of my participation in this event for promotional or publicity purposes without remuneration or obligation to me. Signature______________________________________Date______________ Parent/Guardian Signature_________________________________________ (Parent /Guardian Signature needed if under 18)

AWARDS & PRIZES

Race awards & door prizes will be announced And distributed following the 5K race

1Mile Fun Run/Walk 9:00 a.m. 5K Run Walk 9:30 a.m. Participants meet at Main & Center Streets

RACE DAY DETAILS

DIRECTIONS:
The Town of Chatham, Virginia is located on Hwy 29 between Lynchburg and Danville, Virginia. From the West, take Route 57 East which leads to Main Street; turn North. From the East, take Route 58 West or 360 South to Route 29 North or take Route 57 West which leads to Main Street. From 29 North & South take the Chatham 29 Business exit.

$250 Cash Prize to any Male or Female breaking the course record! $100 Cash Prize for the Best Costume on Race Day (open to all participants and judged by our panel after the race). Trophies/Ribbons to Age Group Winners in multiple categories.

Pre-registration fee - $20.00 ($25.00 after Sept. 20th) Make check payable to: Chatham 5K Race Mail Check and this entry form to: Race Registration Questions? c/o Paul Nicholson paul@wepresentyou.com 702 S. Main Street (434) 489-9480 Chatham, Virginia 24531

STARTING TIMES ON OCT 12th: Race Day Registration: 7:30 a.m. 8:45 a.m. Pre-Reg. Packet Pickup: 7:30 a.m. 8:45 a.m. 1 Mile Fun Run / Walk: 9:00 a.m. 5K Run and 5K Walk: 9:30 a.m. Participants meet at the corner of Main Street and Center Street for all events. Events will run, rain or shine.