10.25.2014 - Jackson, MS

1. DETAILS:
DATE
October 25, 2014
LOCATION
Norman C Nelson Student Union - UMMC
START TIME
8:00 a.m.
EARLY BIRD ENTRY FEE
5K JOG/WALK $25.00, 1-Mile Fun Run $15.00
(1 Mile Fun Run for ages 13 and under)
Early registrants guaranteed a T-shirt
(Early registration ends October 10, 2014)
FEES After October 10, 2014
5K Jog/Walk $30.00, 1-Mile Fun Run $20.00
TEAM REGISTRATION
All Team members must register individually
Team of 10 or more registration -
Fee will be $20.00/person
(Team registration ends October 10)
EARLY REGISTRATION DEADLINE
Must be postmarked by October 10, 2014
ON SITE REGISTRATION BEGINS AT 7:00 a.m.
WALK BEGINS AT 8:00 a.m.
Hosted by
A PORTION OF THE MONEY RAISED WILL BENEFIT THE SICKLE CELL PATIENT FUND
JACK-O-LANTERN 5K JOG/WALK FOR SICKLE CELL REGISTRATION FORM
Circle Event: 5k Jog/Walk 1 Mile Fun Run
NAME: AGE: SEX:
ADDRESS: E-MAIL:
CITY: STATE: ZIP CODE:
PHONE: FACEBOOK:
T-Shirt size (circle one) Youth S M L Adult S M L XL XXL XXXL (add $2.00 to race fee)
TEAM NAME:_
I hereby certify that I am adequately fit to run/walk in this event. In consideration or the acceptance of this entry, I the undersigned, myself, my personal representative, beneficiaries and heirs knowingly waive, release and discharge any and all rightly, organizers and volunteers and assigns for any and all injuries or death suffered by me in this event. I will also allow my picture to be used in publications as a result of the event.
Signature: Date:
(A parent or legal guardian must sign for all participants under the age of 18)
SEND ENTRY FORMS AND FEES TO:
DIVISION OF PEDIATRIC HEMATOLOGY/ONCOLOGY
ATTN: KIM GROSS
2500 NORTH STATE STREET
JACKSON, MS 39216
TELEPHONE 601-815-9295
E-MAIL kgross@umc.edu
Make checks payable to:
Mississippi Sickle Cell Foundation (MSCF)
SICKLE CELL 5K Jack O Lantern Jog