1. Thyroid Thunder
Signature (If under 18, parent or guardian please sign)
Email Address Phone #
Last Name (Please Print) First Name Middle Initial
Street Address or P. O. Box City State Zip Code
Date of Birth Age Sex
Waiver: In consideration of this entry acceptance, I hereby for myself , my heirs, executors, and administrators, waive any and all
rights and claims for damages I may have against Holmes Community College, and any individuals connected with the sponsoring of
the race, and for any injuries, loss, or death sustained by me in the event. I am in good physical condition for this race.
Entry fees:
$20.00 Registration Fee
Proceeds will benefit Kelli Blaylock
Benefit 5K Run/Walk will be held at Holmes Community College,
Goodman Campus for Kelli Blaylock, who is battling Thyroid Cancer.
Saturday, June 29, 2013
Parking: in the large parking lot in front of the McMorrough Library
Race Day Registration:
Begins at 7:30 am in the Courtyard of the Carroll Cafeteria
5K Run starts at 8:00 am and 5K Walk starts at 8:01 am
For more information contact:
Gail Muse Susie Jackson
601-613-0360 662-417-2873
gmuse@holmescc.edu sjackson@holmescc.edu
Date