Jefferson County Family YMCA

1303 YMCA Dr. Festus, MO 63028

Race Results posted on the Jefferson County Family YMCAs Facebook Page Route Map and Entry Form Posted at

www.ymcastlouis.org/jeffersonco

Park at JRMC X-Ray and Imaging adjacent to Crystal Oaks or Park on the Hospital Grounds and Access the area via the pedestrian Bridge.

Saturday, Sept., 8, 2012

Performance Material T-Shirt (Must register by Aug. 30) RACE DAY ENTRY $20.00

8:00 am

NEW!

(Send check to YMCA, 1303 YMCA Dr. Festus, MO 63028. Make check payable to YMCA.) Name________________________________________ Last First Address______________________________________ City__________________ State_______ Zip_______ Phone Number ________________ Sex: M____ F____

Please complete this registration form and return to the Jefferson County Family YMCA.

5K/10K Run-Fun Walk

Saturday, September 8, 2012
Start:
Oaks Oaks

JRMC X-Ray & Imaging Adjacent to Crystal

Finish: JRMC X-Ray & Imaging Adjacent to Crystal Time: 8 a.m., Runners will start and walkers will follow.

*Post-race breakfast provided at finish line.

Race Divisions: Awards will be presented to the top three male and female finishers in each division and best overall male and female finisher. An award ceremony will follow the race. Divisions: 15 & under, 16-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65+. Entry Fees: $15 per person. $25 for a family up to four members and $5 for each additional person. Race day registration $20.00. YMCA definition of family is 2 adults living in the same household and their dependents under the age of 23. Packet Pickup: Packets are available for pickup Friday, September 7 at the YMCA from 1:00-8:00 pm and day of the run at the starting line, September 8 from 6:30-7:45 am T-shirts: The first 200 registrants will receive an attractive performance t-shirt. Your t-shirt and runner number will be in the packet that you will pick up the day of the race. Race Day Registration Ends at 7:45 AM
For more information call the YMCA at 931-9622.

Date of Birth ___________ Age on race day _____ E-mail address ________________________________ Shirt Size: Small _____ Medium_____ Large _____ Extra Large _____

Race Entered 5K run _____10K run_____5K walk _____

WAIVER OF LIABILITY *MANDATORY*: In consideration of this entry, I the undersigned, intending to be legally bound hereby for myself, my heirs, executors, and administrators, waive and release any and all rights and claims for damages I may have against JEFFERSON REGIONAL MEDICAL CENTER, THE JEFFERSON COUNTY FAMILY YMCA, THE CITY OF FESTUS AND CRYSTAL CITY, THEIR REPRESENTATIVES, SUCCESSORS AND ASSIGNS FOR ANY AND ALL INJURIES SUFFERED BY ME IN SAID EVENT.

_____________________________________________ Signature (parent if under 18) _______________________________ Date

SPONSORED BY Jefferson Regional Medical Center and The Jefferson County Family YMCA in conjunction with Twin City Days Festivities.