ARACETOSAVELIVES

ARACETOSAVELIVES
ETOSAVELIVES
Benefitting Choices Pregnancy Resource Clinic
Saturday. November 9. 2013
BONA DEA TRAILS. RUSSELLVILLE, AR
5K Run/WALK, Family 1K, & Virtual Participants
Participants
RACE BEGINS @ 9 a.m.
child strollers
th welcome
$20
Pre-Registration
that
GUARANTEES
your
t-shirt
ends
September
30 !


October
1 st
–
23 rd :
Registration
is
$25.





October
24 th
–
Race
Day:
Registration
is
$30.

Last
Name:______________________________
First
Name:___________________________________
Gender
(Circle
One):




MALE







FEMALE





Birthdate:_________________________
Age
on
11.9.13:________________
Address:_________________________________________
Email:_____________________________

City:________________________
State:_________
Zip:____________
Phone:_______________________
Shirt
Sizing
Info:
All
participants
registered
by
September
30th
are
guaranteed
a
shirt
–
Late/day
of
race
registrants
may
receive
a
shirt
while
supplies
last!

Adult:

(circle
one):
S
M
L
XL
XXL
Youth
(circle
one):





X/S
(2/4)




S
(6/8)






M
(10/12)

L
(14/16)

Event
(circle
one):




5K
RUN
@
9
a.m.


5K
WALK
@
9:05
a.m.
FAMILY
1K
(following
5K)








VIRTUAL
5K
PARTICIPANT

**
Registration
and
Check-
*
Registration
and
Check-In
will
begin
at
8
a.m.
and
end
at
8:45
a.m.
In
will
begin
at
8
a.m.
and
end
at
8:45
a.m.**
n
at
8
a.m.
and
end
at
8:45
a.m.**

**

th
Event
Fees:

All
participants/virtual
participants
registered
by
Sept.

th
30
st
are
guaranteed
a
shirt!

rd
Children
(12
&
Under):




Pre-Register
by
Sept.
30 th:

$10

Oct.
1st
–
23rd:

$15

Oct.
24thth
–
Nov.
9thth:

$20

Teens/Adults
(13
&
up):


Pre-Register
by
Sept.
30 :

$20

Oct.
1
–
23 :

$25

Oct.
24
–
Nov.
9 :

$30

th
Virtual
Participants:







Pre-Register
by
Sept;
30 :

$20



*
virtual
donations
after
this
date
are
not
guaranteed
a
shirt.




Release:
I know that running/walking and volunteering to work in races are potentially hazardous activities. I should not enter and run/walk this race unless I am medically able
and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run/walk. I assume all risks associated with
running/walking and volunteering to work races including, but not limited to, falls; contact with other participants; the effect of the weather, including high heat and/or
humidity; the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and
in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Catch the Beat 5K, Choices Pregnancy
Resource Clinic, Bona Dea Trail, city of Russellville, ArkansasRunner.com, and all sponsors, their representatives and successors from all claims or liabilities of any
kind arising out of my participation in the event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I
grant permission to all the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose.
Signature:______________________________________________________ Date:_______________
Parent Signature (if under 18): _____________________________________ Date:_______________


Please
make
checks
payable
to
Choices
Pregnancy
Resource
Clinic,
P.O.
Box
394
Russellville,
AR
72811


For
electronic
payment,
please
fill
out
the
form
below
and
return
by
mail,
with
registration.







I
request
my
bank
or
credit
card
company
to
make
a
ONE-TIME
transfer
of
$____________.




























































Bank

Draft
Information




Debit/Credit
Card
Information




Checking


(Attach
a
voided
check) VISA MasterCard

Debit
Card
Savings
(Attach
a
voided
deposit
ticket)







Acct
#
___________________
Exp.
Date

______/______









Date
_______________________
Signature
___________________________________________
Please
send
me
newsletters
via
e-mail
address:
_______________________________________
Choices
PRC
–
P.O.
Box
394
–
Russellville,
AR
72811
–
479.967.2255
(office)
–
479.498.4554
(fax)
–
choicesprc.org

Date,
Times,
Location:

Date,
Times,
Location:

• Saturday,
November
9,
2013

• Bona
Dea
Trail,
Russellville,
AR

• 5K
Run/Walk
starts
at
9
AM,
1K
Family
Run/Walk
immediately
following

Entry
Fees:

Entry
Fees:







































By
September
30th





































By
September
30 October
1st-23rd
October
24th-Race
Day

October
24 Race
Day

• Children
(12
and
under):









$10



$15



$20

• Teens/Adults
(13
and
over):



$20



$25


$30


• Virtual
Participants:







$20


$20


$20



Registration:

Registration:
th
Early
Registration
(through
September
30
Early
Registration
(through
September
30
th
)
guarantees
a
t-
)
guarantees
a
t-shirt

shirt

Late
Registration
(after
September
30 )
may
receive
a
t-
Late
Registration
(after
September
30 )
may
receive
a
t-shirt
as
long
as
supplies
last

• Online:
www.choicesprc.org/events.html

(A
processing
fee
will
be
charged
through
raceroster.com
for
credit
cards)

• By
Mail:

Send
completed
form
w/payment
to:


Choices
Pregnancy
Resource
Clinic,
Inc.























P.O.

Box
394























Russellville,
AR
72811

• In
Person:
Choices
PRC
office,
311
E.
3rd
St.
Russellville
AR,
72801


























Office
Hours:

Monday
–
Thursday
8
a.m.
–
4
p.m.

• Race
Day:
Registration
will
be
available
the
day
of
the
race
at
Bona
Dea
Trails
in
Russellville,
AR
from
8
AM
–
8:45
AM

Refreshments:

Refreshments:

• Water
and
other
refreshments
will
be
provided
during
and
after
the
run


Inclement
Weather
Policy:

Inclement
Weather
Policy:

The
race
will
go
on
regardless
of
precipitation.

In
the
event
that
weather
conditions
present
an
imminent
danger
to

participants,
the
race
will
be
cancelled.

No
refunds
will
be
given.



Choices
PRC
–
P.O.
Box
394
–
Russellville,
AR
72811
–
479.967.2255
(office)
–
479.498.4554
(fax)
–
choicesprc.org