Southern Clarion County Ambulance

SOUTHERN CLARION COUNTY AMBULANCE SERVICE

5K Run/2 Mile Walk

Sunday, October 18, 2015, 3:00 pm

Proceeds benefit, SCCAS, life saving equipment

REGISTRATION: 2:15 pm START TIME: 3:00 pm

PROFESSIONAL TIMING by Miles of Smiles

COURSE DESCRIPTION: 5K run/walk will begin at Union High School traveling Baker St to Route 68. The race will travel on Route 68 to Long Lane West, turning around and reversing the route, returning to Union High School. Walkers will go the same course but turn around at the 1 mile marker. The course will be marked accordingly.

AWARDS: Top male and female finisher overall.

Top 3 male and female finishers, in each age group.

15 and under, 16-19, 20-29, 30-39, 40-49, 50 and up

ENTRY FEE: $20 pre-registration by October 4, 2015

$25 after October 4, 2015 and on day of race

Make checks payable to: SCCAS

Forms can be mailed to: 10515 Route 68, Rimersburg, PA 16248

For further information contact: Susan Runyan: sccas@southernclarion.comcastbiz.net

***All participants pre-registered on or before October 4, 2015 will be guaranteed an event t-shirt in their selected size. After October 4, 2015 runners/walkers will receive shirts upon availability.

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Last Name_____________________________ First_________________________

Address_____________________________________City____________________State_____Zip________Date of Birth_____________ Male ? Female ?

T-Shirt size: S, M, L, XL, XXL adult, S, M, L youth

Waiver: In consideration of the acceptance of this entry, I waive for myself, my heirs, and assigns, all claims for damages which I might have against the race, its sponsors , or any other organization, business, or individual as a result of any and all injuries which might be received during the contest. I also release any photos that may involve me.

Signature:__________________________________________ Date________

Signature of Parent:__________________________________ Date________

(if under 18)