The Run for DC 5K

Walkers Welcome!
Saturday, November 3rd, 2012
9:00AM
Simmons Elementary School
830 Tyrone Pike
Versailles, KY 40383
www.run4dc.com

All proceeds will benefit the Simmons Elementary 5th Grade

Trip to Washington, DC
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Registration Options:

1. Register online before November 2nd at www.run4dc.com - Preferred Option!

($25.00)
2. Mail the Registration form below to Simmons Elementary School, 830 Tyrone Pike, Versailles, KY
40383. Please include a check for $25.00 made out to Simmons Elementary School with your form. If sending it
through the mail, your form MUST be postmarked before October 29th or else we wont get it on time!
3. After October 29th, you can drop your registration form off at Simmons Elementary ($25.00)
4. Race day registration from 7:30 - 8:45 ($30.00)

Packet pick up will be on November 2nd from 9:00 - 5:00 at Simmons Elementary and on Race Day
Awards: Overall Female and Male; Top three male and Top three female in each age group:
9 & under, 10~12, 13~16, 17~19, 20~24, 25~29, 30~34, 35~39, 40~44, 45~49, 50~54, 55~59, 60~64, 65~69, 70+
-------------------------------------------------------------------------------------------------------------------------------------------The Run for DC ENTRY FORM (return this portion with payment):
Name: _______________________________________________________________________________________
Address: _____________________________________________________________________________________
City: _________________________ State: _____ Zip: _______ Phone: (______) ________ - ________________
Sex: (Circle one) M / F

Date of Birth ________/________/________ Age on race day: ________________

Email: ________________________________________________________________________________________
Shirt Size: (Circle one): YM, YL, S, M, L, XL, 2XL, 3XL (First 100 people to register are guaranteed a t-shirt!)
WAIVER: Each person participating in the Run for DC is required to sign this waiver. In consideration of the acceptance of my entry,
I for myself, my heirs, executors, and administrators, do hereby release and discharge Simmons Elementary School, Woodford
County Schools, the Run for DC and all sponsors, volunteers and associates of this event from any and all claims in said event. I
certify that I have full knowledge of the risks involved in participating in this event, and I am sufficiently trained to participate in this
event.

SIGNATURE: (Parent / Guardian Signature if under 18):

___________________________________________________

Date
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