Entry Fees (Non-Refundable)

$20 day of race, $15 Pre-registration, $10 Student Rate

Free T- Shirts to race participants, who pre-register by May 13, 2011

Mail in the registration form to:

Waynesville Area Chamber of Commerce

P.O. Box 281

Waynesville, Ohio 45068

Make checks payable to: Waynesville Area Chamber of Commerce (WACC)

Contact Chamber office at 513-897-8855 for more information.

CHECK-IN AND REGISTRATION: Friday May 20 (3pm-6pm) or May 21 (7:30-8:30am).

Packet pickup for pre-registered will be 3pm-6pm Waynesville High School Lobby.

Awards: Offered to the Top Overall Female and male runner and walker. NEW THIS YEAR

KIDS 1 MILE FUN RUN (eligible for children 12 and under). It will be located at Wayne Local School track, with a start time of 10:30 am.

Information: Visit www.waynesvilleohio.com or call 513-897-8855. To register online visit www.speedy-feet.com online registration, pictures and results available after the race.

Name: _________________________________________________________________

Address:_______________________________________________________________

City, State, Zip _________________________________________________________

Male__________Female______________(please check one) ________Age(race day)

Phone _____________________________

E-Mail ____________________________

T-Shirt Size: S- M- L- XL- XXL- XXXL Circle one

Emergency contact________________________________________________Phone________

REQUIRED

Waiver: All registrants are required to sign this waiver. In consideration of the acceptance of my entry, I hereby waive discharge and release on behalf of my heirs, executors, and assigns, all claims of any nature, including but not limited to damages, actions, whatsoever in any manner, arising from my participation on the Waynesville Community Day 5k Run/Walk., and do hereby release Wayne Local School District, Waynesville Chamber of Commerce, and Waynesville Police Department employees, trustees, sponsors, worker, officials, and volunteers from any claim whatsoever arising from this event. I agree to abide by all rules of participation, and acknowledge that the Waynesville Chamber of Commerce may refuse or return my entry at its discretion. I attest and verify that I understand the risks involved in such a run/walk, and that I am physically fit and have trained adequately in preparation. I give the Waynesville Chamber of Commerce permission to take my photograph during the event and use in its publicity, media, and marketing material.

Signature: _____________________________________________Date_____________________