MISSION TAKE BACK 5K & 2 MILE WALK

KIDS 800M RACE (FREE) 12 & under

ALL KIDS WILL RECEIVE A FINISHERS MEDAL!

SUNDAY, October 7, 2012 2:00 PM

RACE STARTS AT THE PISGAH UNITED METHODIST CHURCH

SPONSORED BY THE BRUCETON CROSS COUNTRY TEAM AND THE PISGAH UNITED METHODIST CHURCH

Make checks payable to: Pisgah United Methodist Church

Mail to: Ron Hamric 246 Laurel Run Rd. Bruceton Mills, WV 26525 Phone 304-288-3873

Name:__________________________________Phone:___________

Address:__________________________________DOB:__________

Age as of 10/7/12:__________________Male:_____Female:_______

Walk_____Run_____

Early Registration: $15 MUST BE POSTMARKED BY 09/30/12

Race Day Registration: $18.00

T-shirt size Small____Medium____Large____X-Large___

In consideration of your acceptance of my application for entrance in the Mission Take Back and Bruceton Cross Country Team 5k, I, for myself and anyone entitled to act on my behalf, waive and release Pisgah Church and Bruceton Cross Country Team and all sponsors their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. I also release any photos that may involve myself:

Signature:___________________________________________Date______________________

Entrant’s Signature Parent or Guardian, if under 18:

Signature:___________________________________________Date_______________________

Race Course: Double out & back starting and ending at the Pisgah Church. Paved & gravel roads on rolling hills. Water will available on the course.

Race-Day Check In: Parking is available at the Pisgah Church and registration is from 12:30 p.m. – 1:30 p.m. Pre-registered runners are guaranteed a t-shirt, availability not guaranteed on race day.

Entry Fee: If you register before September 30, 2012, the registration cost is $15.00. All entrants who register after September 30 will be charged $18.00. Fees are nonrefundable.

Awards: Awards will be given to the top three overall male and female running finishers as well as the top two male and female running finishers in each of the following age groups: 14 and under; 15-19; 20-29; 30-39; 40-49; 50-59; and 60 and over. Awards will also be given to the top three overall male and female walkers

Directions: Coopers Rock exit 15 on I-68. Take old route 73 east towards Bruceton Mills. Take first road to the right, crossing over I-68 & continue approximately 1 mile to Pisgah. Please call Michelle Hamric with any questions. 304-288-3873