1st Annual Smilin Waylons Run for the House 5K Race

November 2nd, 2013

Start Time: 8:00 A.M. (EST) Start / Finish Location: Callaway Stadium ! ! ! 801 Dallis Street ! ! ! LaGrange, GA 30240 This is a fast 5K course that is USATF certied and can be used as a 2014 Peachtree Road Race Qualier. Registration Options: 1) On-line at http://waylonsrun.eventbrite.com 2) Mail in this completed form and check. Must be postmarked by 10/25 3) Race Day registration starting at 7:00 A.M. Cost:! ! ! ! ! ! Mail in Registration !! ! ! Online Registration (closes 10/28)! Race Day Registration ! ! ! 5K ! $20! $25! $30! Fun Run $5 $5 $5

All proceeds beneting the

Connect with us at facebook.com/Waylonsrun

All advance registrants will receive t-shirts on race day.

Smilin Waylons Run for the House Entry Form

5K! Fun Run! ! First Name: _________________! Last Name: ___________________

Address: __________________________________ City/State: _________________ Zip: _______ Date of Birth: ____/____/____! Gender: M ! ! YM YL F! ! Age on Race Day: _____

Phone:_______________________ ! T-Shirt Size (Circle One): YXS YS

Email: ____________________________________ YXL AS AM AL AXL AXXL (add$2)

Optional Donation to Ronald McDonald House: $__________ Total Amount Enclosed: $_______ Signature (if under 18, parent or guardian): ___________________________________________ Make Checks payable to Brack Hassell and mail to: Brack Hassell 416 Jefferson Street, LaGrange GA 30240

Waiver: I know that running a 5K race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of race officials relative to my ability to safely complete the run. I assume all risks associated with running this event including, but not limited to, falls, traffic and conditions of the road, contact with other participants, injuries or illness from animals or plants, the effects of weather and all risks associated with event participation. Having read this waiver and knowing these facts and in consideration of you accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the race director, volunteers, sponsors, all city, county and state governments from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of persons named in this waiver. I understand that all entries are final with no refunds. The official race director reserves the right in any event of emergency or local or national disaster to cancel the race or to change the day and or time to a later day and that in the event of cancellation or change there is no refund of entry fees. The right to reject any entry or to issue special invitation is reserved.