5K Entry Form

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Packing Up to Pound the Pavement

April 21, 2012 At 9:00am


The First Annual Packing Up to Pound the Pavement 5K will be held on April 21, 2012. This event is put on by the Granger Volunteer Fire and EMS departments to help with the purchase of new air packs. One thing that will make this 5K different is our Real Heros Relay. The Real Heros Relay is a 3.1 mile relay of three firefighters with full turnout gear (No Air tank, Mask, Hood, or gloves) on. Anything that you leave the start line with must go across the finish line with you. The first two firefighters will each run a mile with the third running the remaining distance. There will be a baton that must be handed off to the next runner and carried across the finish line for that teams time to be counted. If your department thinks it has what it takes come and show it. The 5K (3.1 mile), and Real Hero 5K Relay (3.1 mile) courses start and finish at the Granger Fire Station. Registration / Packet Pick-Up will be from 6:00 8:45 at the Fire Station located at 1906 Main Street in Granger, Iowa. All paid adult participants will receive a commemorative T-shirt. Immediately following the events, snacks and refreshments will be provided and medals will be awarded. Awards: Medals will be awarded to the first, and second place finishers in each age division for male & female 5K runners. Trophies will be awarded to the first, second, and third place teams in the Real Hero Rely. Additional Information: All proceeds go to the Granger Fire Department Auxiliary. For additional information regarding this event please contact Greg Besch at 515-460-4142 or Granger5K@gmail.com Entry forms and race results will be available at FitnessSports.com

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ Detach and Mail to: Granger Emergency Services Aux, PO Box 133, Granger, IA 50109 Make checks payable to: Granger Fire Aux
Event: __________ 5k ($20 up to April 7 / $25 after) ________Real Hero Relay ($25 up

to April 7th / 30after) Name, Last:_________________________________________________ First: _________________________________ Age: ____13 & under ____14-19 ____20-29 ____30-39 ____40-54 ____55 & over Male____ Female: ____ Address:_________________________________________________________________________________________ Gender:

City:________________________________________________________ State:________ Zip: __________________ Phone: ________________________________ email: ____________________________________________________ In case of emergency, contact: ________________________________________phone #_______________________ Event: __________ 5k ($20 up to April 7 / $25 after) __________Real Hero Relay ($25 up

to April 7th / $30after) Shirt Size: M______ L______


Real Hero Team Name:_______________________________________________________ Department:_______________________________________________________________ Name of Team Members:

Adult S______ M______ L______ XL______ XXL______

Youth S______

Last:_________________________________________________First: _________________________________ Shirt Size: Adult S______ M______ L______ XL______ XXL______

Last:_________________________________________________First: _________________________________ Shirt Size: Adult S______ M______ L______ XL______ XXL______

**Signatures and other information will be needed from other team members the day of the event.
*WAIVER OF LIABILITY: I understand and acknowledge that running a road race is a potentially dangerous activity that should only be undertaken by individuals who have adequately trained and are medically able. I assume all risks, whether known or unknown, associated with participating in this event including but not limited to medical emergencies brought on by physical exertion, falls, contact with other participants, effects of weather, traffic and conditions of the road, all such risks being known and appreciated by my heirs, executors and administrators, do hereby waive, release and discharge volunteers and event coordinators as well as the City of Granger, and all sponsors, their representatives and successors, from all claims and liabilities of any kind resulting from or arising out of my participation in the event including personal injury or damage suffered by me or others, even though such claims or liability may arise out of negligence or carelessness on the part of the persons named in this waiver.

Signature__________________________________________________________________ Date__________________
* Parent or Guardian must sign the waiver for anyone under 18 years (list relationship to minor)

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