1. Date
IMHIVIS CHEERLEADER &
LACK &
GOLD 5K CRAZY RUN AMD 1
MILE FUN RUN
Saturday, May 11th
, 2013 at 8:00 am
Late Registration & T-shirt Pick ups 7:00-7:45am LOCATION:
New Hope Middle School
AWARDS: lu
, 2»d
& 3rd
place medals foreach age group in 5K Run I*. 2"1
' & 3rd
place
medals for overall In Fun Run CONTEST: Best Group & Individual Crazy Costume
(optional)
RACE FEATURES: Traffic Control, Water and T-Shirts
COURSE: Race begins and ends at New Hope Middle School parking lot
ENTRY FEE: By April 30,h
• 5K $20.00, After April 30* S2S.00
Fun Run $10.00, After April 30'* $15.00
Please make checks payable to Jr. High Cheer Boosters
Mail Applications to: Elizabeth Malone, 123 Kings Path, Columbus, MS 39702 for questions, call 662-
574-0673 or Drop off applications at NHHS
Piejsc Print
NAME______________________________________________PHONE ____________________
ADDRESS __________________________________ CITY ________________ STATE ______
Email___________________________________________________ AGE________ SEX M/F
Enclosed Amount $ ____________________________ T-shirt Size ________________________
GENERAL RELEASE & WAIVER: In consideration of my acceptance as a participant in the Black & Gold
5K Run, I hereby (or myself, my heirs, executors and administrators, do waive and release any and all rights
and claims for damages I may have against the sponsors of the run or any other group or persons involved
with this 5k Run for any and all claims or liability. I also certify that I am physically fit to
compete in this event. Signature of participant (parent or guardian's signature required if
under 1H years of age.)
Signature
AGE GROUPS: Male or Female
Up to 14 15-19 20-24 25-29
30-34 35-39 40-44 45-49
50-54 55-59 60-64 65 and up