1. Union’s Country Day 5K Run/ Walk
Kids’ 1 Mile Fun Run
Saturday, August 24, 2013
Race Day Registration: 5K Run Awards
Race Start Time: 7:30 a.m.
Start Location: Truhitt’s Texaco Service Station, 109 East Jackson Road/ Hwy 492
All Participants will receive a T-SHIRT!
Refreshments (Cold drinks and snacks) will be provided to all participants at the finish.
Registration: Registration Fee: $20
Runners will be allowed to register up until race- day with a fee of $25.
You may pre-register by mailing in the registration below and personal check to the following address: Please Note: All
personal checks must include Cell number and Driver’s License Number.
Payable to: Union Chamber of Commerce
P.O. Box 90
Union, MS 39365
Entry Form
Union’s Country Day Run 5K Run/Walk Kids’ 1 Mile Fun Run Saturday, August 24, 2013
NAME__________________PHONE (___)________-________________ MALE______FEMALE_____
ADDRESS___________________________ CITY___________STATE______ZIP CODE___________
E-MAIL: __________________________________________________________________________
Please select one: 5K Run _________ 5K Walk________ Kids’ 1 Mile Fun Run ___________
T SHIRT SIZE (Circle one) Small, Medium, Large, Extra- Large, XX-Large
Participant Waiver and Release
I waiver any and all claims for myself, my heirs, and assigns, against Union Chamber of Commerce, all race co- sponsors and town of
Union, and subsidiary or political subdivision thereof, it or their representatives, successors, and assigns for injury or loss which may
result directly or indirectly from participation in this event. I further state that I am in proper physical condition and have trained for
completion of this event. Further, I hereby grant full permission to any and all of the forgoing to use any photographs, videotapes, or
any other records of this event for any purpose whatsoever. No refunds.
Age: _______ Signature:_____________________________ Date:_________________________________