3rd Annual Relay For Life of McIntosh Co.
5Kickoff Run/Walk and 1 Mile Fun Run/Walk
“One step closer to finding a Cure”
WINGS members get a $5 discount. The need to write WINGS at the top of the entry form and subtract the $5 from the entry fee.
Date: Saturday, March 29, 2014
Time: 6:45 AM- Registration and Packet pick-up opens
8:00 AM- 5K will start
8:05 AM- 1mile fun run/walk will start
Location: Truman Dixon Gym, Downtown Checotah, OK
Registration Fee: $25 for 5K
$20 for the 1 mile fun run/walk
(Price goes up $5 if you register day of event)
Registration form and check due by March 17th in order to guarantee T-shirt!!
A Prize will be awarded to the top Male and Female finisher in each age group:
1) 18 years of age and older
2) 13-17 year old.
Which event will you be participating in? (Circle one) 5K 1mile fun run
Name: ______________________________________________ RFL Team Name (if applicable) ______________________
Phone Number: ___________________________ Email: _____________________________________
Adult T-Shirt Size (circle one): S M L XL XXL No shirt desired
Make Checks Payable to: Hodge Podge/Relay For Life Total Amount Paid: __________________________
Please sign the waiver statement below for each participant, including children:
I, the undersigned, in consideration of acceptance of the entry and registration as participant in the 5Kickoff/1 mile fun run, waive any and all claims which I and my heirs or assigns may now or hereafter have against the McIntosh Relay for Life committee, its members, or the city of Checotah, and all officials, volunteers and sponsors of the 5Kickoff/1 mile fun run, which may indirectly or directly result from my participation in the 5Kickoff/1 mile fun run. I further warrant and represent that I am in proper physical condition to participate in the 5Kickoff/1 mile fun run and am not participating in this event against physician's advice nor am I taking medications which would impair my health or ability to participate in the 5Kickoff/1 mile fun run. Further, I grant permission to all of the foregoing to use any photographs, motion pictures, recordings or any other record of this event for legitimate purposes.
Signature (parent or guardian if minor) _____________________________________ Date ________________
Please complete the above information and turn in with payment at Dentures and Dental Services in Checotah or send this form along with your check made payable to the Hodge Podge/Relay For Life to:
4111 Eagle Crest Dr.
Muskogee, Ok 74401
Please be sure that this will arrive on or before the March 17th deadline to guarantee your t-shirt!!
For any questions, please contact 5K Chair, Rachael LaBounty at 918-441-5569 or email@example.com.
Click here or the image below to download the race registration form