1. Burnsville Waterway Festival
22nd Annual 5K Run
SATURDAY, SEPTEMBER 28, 2013
RACE HEADQUARTERS AT BURNSVILLE CITY HALL
Registration will begin at 6:45 and the race will start promptly at 8:00 am
Trophies Awarded to Overall Male and Female Winners
1st
, 2nd,
and 3rd
Place Winners will receive trophies for both Male and Female
in the following age divisions:
0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 60-64 65-69 70+
(There will be no duplication of Trophies)
Advanced Registration Fee is $15.00 (Pre-payment is due by September 21)
If you have a specific T-shirt size that you need, please remember to pre-register!!
Name; First________________________ MI_______ Last____________________________________
Address ___________________________ City____________________ State_________ Zip _________
Phone _________________Age on 9/22/12___________ Sex ___________ T-shirt Size____________
Mail check to: Burnsville Waterway Festival 5K Run, 8 Carpenter Drive, Burnsville, MS 38833
(No Refunds on Entry Fees)
Contact Niesha Carpenter at 662-284-6922 or 662-427-9526 for any questions
Registration the Day of the Race will be $20.00
* All Runners will receive a T-shirt * Flat Course * Water Station on Course
* Splits Called at Each Mile *Post Race Refreshments
* Fast Results & Trophy Presentation
WAIVER MUST BE SIGNED (if runner is under 18 – form must be signed by parent or guardian)
I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and
properly trained. I assume all risks associated with running in this event including but not limited to falls, contact with other
participants, the effects of the weather, including high heat and/or humidity, the condition of the road and traffic on the course, all
such risks being known and appreciated by me. Having anyone entitled to act on my behalf, waive, and release, the Burnsville
Waterway Festival Run, City of Burnsville, MS, and all sponsors, their representatives and successors from all claims or liabilities of
any kind arising out of my participation in this events even though that liability may arise out of negligence or carelessness on the
part of the persons named in this waiver. I also grant permission for the use of any photography, motion pictures, recordings or any
other record of my participation in this event for any legitimate purpose.
Signature: ___________________________________________________Date ___________________
This form may be copied or emailed to other runners interested in competing in the 5K Run.