2011 Mission:1 5k Race
And
2k Fun Run/Walk
Sat., Nov. 12, 2011**9AM**
A 1st year event around the
mature neighborhoods surrounding The Reformed Church of the Ascension, 1700
Main St, Jeffersonville, PA 19403. Proceeds go toward charities (to feed the
hungry and confront food-related injustice) supported by the church. Come tour
our suburban neighborhoods and roads just outside
Registration:
Opens at 8 AM. Both 5k and 2k event
start at 9.
Entry Fee:
for both 5k and 2k, $20 if postmarked by Sat, Oct 29th, 2011; guarantees a
shirt of the size you request. Afterwards, including race
day, $25 while shirts last, $18 when they're gone. Free post-race refreshments
for all, plenty of parking, indoor toilets and other niceties.
Awards: for
5k only. 1st overall M & F + age
group awards for both males and females
Please complete the
registration form below, including signature, and mail it and a check (payable
to The Reformed Church of the Ascension)
to Mission:1 5k, The Reformed Church of the
Ascension 1700 Main St, Jeffersonville, PA 19403.
For Info: Call Tonda
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(One form per
person – Please WRITE NEATLY!!)
Name______________________________________________________________
Address________________________________ City____________________ State____ Zip_______
Gender: M_____ F_____ Age on race day _________ Date of Birth ___/___/___
Phone____________________ E-mail_______________________________
Race: 5K_____ or 1Mile_______ Tee Shirt Size (circle): S M L XL
Race waiver: In consideration of the acceptance of this entry, I
hereby, for myself, my heirs, executors and administrators, waive and release
all rights and claims for damages I may have against the organizers, sponsors,
volunteers, officials and any other individuals associated with this event and
will hold them harmless from any injury suffered by me. Also, none of the above
are responsible for the loss of personal items nor any
other form of aggravation in connection with said event. I understand that road
racing is a potentially hazardous activity.
I verify that I am physically fit to participate in this event.
Signature _________________________________ Date __/___/2011 Entry fee enclosed _______
(parent's signature, if entry is under 18 Added donation (optional) _______
Total Enclosed _______