CHANDLERVILLE BURGOO

BOOGIE 5K
Don’t forget about all of the other
festivities of the Chandlerville Burgoo
Celebration!
Participants and friends/family are
encouraged to stick around after the
race to watch the parade on Saturday at
10am, then journey to the pavilion for
some fresh-stirred Chandlerville Burgoo!!
REGISTRATION FORM
DATE: Saturday, August 22nd, 2015
STARTING TIME: 7:30am
LOCATION: Race starts and ends at the Chandlerville Community Building (located on
Orchard Street, ½ block East off of Main Street)
ENTRY FEE: $25.00 with T-shirt $20.00 without T-shirt
MUST REGISTER BY JULY 31ST TO GET A T-SHIRT. We will not have extra t-shirts
on race day, so please pre-register by July 31st to ensure you get a T-shirt.
REGISTRATION: Pre-registration with a T-shirt ends on July 31st.
Pre-registration without a T-shirt ends on Thursday, August 20th.
Race-day registration from 6:45am-7:15am.
AWARDS: First Place Overall
First and Second Place Medals will be awarded for both Men’s and Women’s in the
following age categories:
20 and under, 21 to 39, and 40 and over.
EXTRA T-SHIRT ORDERS: If you would like to order extra T-shirts, cost is $12/shirt. Orders
must be received no later than July 31st.
ALL T-SHIRTS will be distributed on race day. We will NOT mail shirts to those who
cannot make it, so please make other arrangements to have someone retrieve shirt(s)
for you or to pick them up another time during the Burgoo.

Please return this section plus

Chandlerville Burgoo Boogie 5K – REGISTRATION FORM payment to:
Kelli Turner
___________________________________, ______________________________
Last Name First name
P.O. Box 44
Chandlerville, IL 62627
______/_______/_________ Age on August 22ND, 2015: __________
Date of Birth Make checks payable to:
Chandlerville Improvement Council
Sex: M F E-mail:________________________________________

Phone Number: ________________________________

Race/T-shirt Options (please mark those that apply):
I will be participating in the 5K ONLY, no T-shirt. ($20)
I will be participating in the 5K and would like a T-shirt. ($25) Total Payment Enclosed:
My Shirt Size is: S M L XL XXL
$ _________
I would like to purchase extra T-shirt(s) at $12.00/shirt.
(Please place a quantity next to the size(s) of additional shirts desired.)
_____ S _____M _____L _____XL _____XXL

I have read and agree with this

Waiver of Liability: I agree that by participating in the Chandlerville
Waiver of Liability and wish to Please direct any questions
Burgoo Boogie 5k, I do so at my own risk. I assume all risk of injury,
illness, and damage or loss to me or property. I have trained in a participate in the Chandlerville to Kelli Turner at:
sufficient manner and attest that I am physically prepared to Burgoo Boogie 5K. Kellit2015@gmail.com
participate in this event. I will not hold the Chandlerville Improvement ________________________ OR
Council or any other individual(s) or group(s) liable for any accident or Signature Date
incident which may occur at this event. 217-371-8424
________________________
Parent’s Signature (if under 18) Date