1. 2012 1st Annual
DIERS
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5K
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Benefitting the
U.S. Wounded Soldiers
Foundation
Location: GreatLife Golf and Fitness (formerly the Lebanon Country Club)
TIme: 9:00am for registration • 11:00 am is Start Time Sunday March 18, 2012
Weather: Only lightning, thunder, HEAVY downpour or BLIZZARD will cancel event.
WILL run in case of light snow
Make Up Date: If cancelled due to weather make up date will be announced.
Register: Pre-register by FEB 27, or on race day beginning at 9:00am
Fees: PRE REGISTER by Feb. 27th and fee will be $29 / Day of event $39.
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2012 5K Entry Form T-Shirt
Race T-shirts are available
Male Female
for $15.00. Must pre-register
2012 1st Annual to recieve a shirt.
Name: A limited number of shirts
5K
will be available for purchase
Address:
on race day!
City: State: Zip: XXL & larger are an
additional $3.00 per shirt.
Phone:
Email: S M L XL XXL
WAIVER: I should not enter and run unless I am medically able and properly trained. I also assume any and all other risks associated with running this event including, but not limited to falls, contact with
other participants, the affects of the weather, all such risks being known and appreciated by me. I also am fully aware that animals are strictly prohibited and I agree not to have them on the course.
Furthermore, I agree not to go back onto the course after finishing. Knowing these facts, and in consideration of your accepting my entry, I hereby for myself, my heirs, executors, administrators or anyone
else who might claim on my behalf, covenant not to sue, and waive and release and discharge, GreatLife Golf & Fitness, 2012 Warrior Run, Wounded Warrior Charity, and all race sponsors, race officials,
volunteers, local and state police including and all of their agents, employees, assigns or anyone acting for or on their behalf from any and all claims or liability for death personal injury or property
damage of any kind or nature whatsoever arising out of, or in the course of, my participating in this event. This release and waiver extends to all claims of every kind or nature whatsoever, foreseen or
unforeseen, known or unknown. The undersigned further grants full permission to sponsors and or agents authorized by them to use any photographs, video tapes, motion pictures, recordings or
any other record of this event for any purpose. Applications for minors accepted only with a parent or guardian signature.
Signature: Date:
Parent/Guardian Signature: (Required for participants 18 years and under)
Contact information / completed entry forms: Special thanks to:
Tommy Barker c/o Kickin It Martial Arts • 1126 Tyler Drive • Lebanon, MO 65536
Phone: 417-718-0250 • Email: tommy_barker@hotmail.com
Please make check payable to : KICKINIT MARTIAL ARTS PROCEEDS GO TO U.S. WOUNDED SOLDIER FOUNDATION