The Mustang Madness 5k is a benefit run on February 28, 2015 at 9:00 am to support the Mantachie Elementary 5th and 6th grade running program. Participants must fill out a registration form providing their contact information, age, t-shirt size, and signed waiver absolving the organizers of liability. Forms and entry fees of $20 before February 14 or $25 on race day can be mailed to Mantachie Elementary School.

1. Mustang Madness 5k
Benefit t ing the Mantachie Elem. 5t h and 6t h grade running program
Feb. 28, 2015 9:00 am
Name:____________________________
Gender: Male / Female Date of Birth: _________ Age on Race Day:__________
Age Divisions: 9 and under, 10-14, 15-19, 20-29, 30-39, 40-49, 50-59, and 60 &
over (please circle age division).
Email:______________________________________________
Phone:______________________________________________
Address:_____________________________________________
City: State: Zip:________________________________________
$20 (through Feb 14) $25 (Day of Race)
Please circle one: YS YM Y L S M L XL XXL
Make Check Payable to: Mantachie Elementary PTO
WAIVER: (must sign waiver to participate)
I do hereby absolve all race sponsors, volunteers, race officials, and organizers from all claims of
damages, demands, actions, and courses of action whatsoever, in any manner arising or growing out
of my participation in the Mustang Madness 5k. I certify that I have prepared
myself and that I am in adequate physical condition to participate in the event.
Signed_______________________________Date____________
Parent (if under 18)____________________Date____________
Forms may be mailed to : Mantachie Elementary School
c/o Elizabeth Kelly
P.O. Box 38

2. Mantachie, MS 38855