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5K Run is
                                                                                                                                sponsored by
                                                                                                                                OCH Regional
                                                                                                                                Medical Center
                                     Old Cotton Mill 5K Run
                                       and 1 Mile Fun Run

                                         Mail registration fee to:
                                  Cotton District Arts Festival – 5K Run
                                          Starkville Arts Council
                                    101 S. Lafayette Street, Suite 18
                                       Starkville, Mississippi 39759
                       Make checks payable to: Cotton District Arts Festival – 5K Run
                           or you can register online at: www.racesonline.com
                                                                                                                             CERTIFICATION
                                                                                                                                   # MS11012MS

                                                                                                                                  RACE DAY
                                                                                                                               Saturday, April 20, 2013
________________________________________________________________________________________
                                                                                                                                5K starts at 8:00 am.
First Name					Last Name
                                                                                                                                  Fun Run begins at
                                                                                                                                approximately 10 am.
________________________________________________________________________________________
EMail
                                                                                                                              REGISTRATION
                                                                                                                              Early-Bird Registration for
________________________________________________________________________________________                                    both the 5K and Fun Run goes
Address                                                                                                                        through March 1, 2013.

________________________________________________________________________________________
                                                                                                                              Regular Registration for
City						State				Zip
                                                                                                                            both 5K and Fun Run begins
                                                                                                                                on March 2 through
________________________________________________________________________________________
Phone						Cell Phone                                                                                                             April 19, 2013.

                                                                                                                                Race-Day Registration
Age on Race Day: _______________________________ Sex: _______________________________________                                     opens at 7:00 am
                                                                                                                                    on Saturday,
                        T-Shirt Size (5K Only): S M L XL XXL (Circle One)                                                          April 20, 2013.


                        All Fun Run participants will receive a Finisher’s Medal
                                                                                                                                 ENTRY FEE
                                                                                                                             Early-Bird 5K          $20
                                                                                                                             Regular 5K             $25
Waiver: In consideration of acceptance of this entry, I waive any and all claims for myself and my heirs against             Race-Day 5K            $30
officials or sponsors of the Old Cotton Mill 5K Run for injury or illness which may directly or indirectly result from my
participation. I further state that I am in proper physical condition to participate in the event.
                                                                                                                             Early-Bird Fun Run     $10
                                                                                                                             Regular Fun Run        $10
________________________________________________________________________________________
                                                                                                                             Race-Day Fun Run       $15
Runner’s Signature					Date
(Entrants younger than 18 years old require a parent or guardian signature)

________________________________________________________________________________________
Guardian’s Signature				Date

                     Award Ceremony Following the 5k Race (approximately 9:15) on Stage 1
         Run Divisions / Group (under 14, 15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49, 50–59, 60+)
                                           For more information contact
                                                  Kristen Coghlan
                                               kcoghlan@garan.com
                                                   662.312.5798.

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2013 old cotton mill 5 k application

  • 1. 5K Run is sponsored by OCH Regional Medical Center Old Cotton Mill 5K Run and 1 Mile Fun Run Mail registration fee to: Cotton District Arts Festival – 5K Run Starkville Arts Council 101 S. Lafayette Street, Suite 18 Starkville, Mississippi 39759 Make checks payable to: Cotton District Arts Festival – 5K Run or you can register online at: www.racesonline.com CERTIFICATION # MS11012MS RACE DAY Saturday, April 20, 2013 ________________________________________________________________________________________ 5K starts at 8:00 am. First Name Last Name Fun Run begins at approximately 10 am. ________________________________________________________________________________________ EMail REGISTRATION Early-Bird Registration for ________________________________________________________________________________________ both the 5K and Fun Run goes Address through March 1, 2013. ________________________________________________________________________________________ Regular Registration for City State Zip both 5K and Fun Run begins on March 2 through ________________________________________________________________________________________ Phone Cell Phone April 19, 2013. Race-Day Registration Age on Race Day: _______________________________ Sex: _______________________________________ opens at 7:00 am on Saturday, T-Shirt Size (5K Only): S M L XL XXL (Circle One) April 20, 2013. All Fun Run participants will receive a Finisher’s Medal ENTRY FEE Early-Bird 5K $20 Regular 5K $25 Waiver: In consideration of acceptance of this entry, I waive any and all claims for myself and my heirs against Race-Day 5K $30 officials or sponsors of the Old Cotton Mill 5K Run for injury or illness which may directly or indirectly result from my participation. I further state that I am in proper physical condition to participate in the event. Early-Bird Fun Run $10 Regular Fun Run $10 ________________________________________________________________________________________ Race-Day Fun Run $15 Runner’s Signature Date (Entrants younger than 18 years old require a parent or guardian signature) ________________________________________________________________________________________ Guardian’s Signature Date Award Ceremony Following the 5k Race (approximately 9:15) on Stage 1 Run Divisions / Group (under 14, 15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49, 50–59, 60+) For more information contact Kristen Coghlan kcoghlan@garan.com 662.312.5798.