GET PHYSICAL 5K RUN & 1.5 MILE WALK

Other races – 12 & under ½ Mile Run and Relay Teams for 5K
 
REGISTRATION FORM
Location: Lebanon Physical Therapy & Rehab Svc.
272 Highland Drive (Behind Wendy’s) Lebanon, VA
 
Schedule: Friday, August 10, 2018
6:00 pm - Registration Starts
6:30 p m - 1.5 Mile Walk
7:00 pm - Kids ½ Mile Run
7:30 pm - 5K Run
Cost:
Prior to August 9, 2018-            $25      ($35 for Team- 3 Person team, each run 1 mile)
Day of Race-                                 $30      ($45 for Team- 3 Person team, each run 1 mile)
Kids-                                                  $20
LPT Group Fitness Member - $20

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Awards (Men & Ladies)/ Top 3 Overall & Top 3 Masters/ Top 3 each Age Group
15 & below, 16-19, 20-29, 30-34,35-39, 40-44, 45-49, 50-59, 60 & above
(Awards for top three finishers in 1.5 walk & ½ mile run)

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Mail payment to: Lebanon Physical Therapy, P.O. Box 1387, Lebanon, Virginia 24266
Contact: Robert Weatherly, DPT/Greg Cornforth, DPT – Phone: 276-889-409

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MY HEIRS, EXECUTORS, AND ADMINISTRATORS, WAIVE, AND RELEASE FOREVER ANY AND ALL RIGHTS AND CLAIMS FOR DAMAGES I MAY HAVE AGAINST THE ORGANIZERS AND SPONSORS OF THIS EVENT. I ALSO RELEASE THE ABOVE NAMED FOR ALL CLAIMS OF DAMAGE DEMANDS, AND ACTIONS IN ANY MANNER DUE TO ANY PERSONAL INJURGIES, PROPERTY DAMAGE, OR DEATH SUSTAINED AS A RESULT OF MY TRAVELING TO AND FROM AND MY PARTICIPATION IN THE RACE. I ATTEST AND VERIFY THAT I AM PHYSICALLY FIT AND HAVE SUFFICIENTLY TRAINED FOR THE COMPETITION OF THIS EVENT. IN FILLING OUT THIS FORM, I ACKNOWLEDGE I HAVE READ AND FULLY UNDERSTAND MY OWN LIABILITY AND ABILITY.