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March 1S 2014
8eglsLrauon beglns aL 700 am
8easley's urug Company 933 CenLer SLreeL
uownLown Conyers CA
lun 8un beglns aL 830 am
3k beglns aL 900 am
Rockdale County
Entry Form (one per participant)
Last Name__________________________________First Name_____________________________________
Age on race day______________Birthdate____/_______/_____Sex______M_______F
Address (Number and Street) ________________________________________________________________
City ________________________________________ State_____________ Zip Code___________________
Home Phone (Optional) _____________________Email-__________________________________________
Waiver: I hereby release the sponsors and officials of the 3rd Annual Rock On Rockdale from all claims of injury or damages resulting
from participating in this event. I realize this is a strenuous event which requires proper physical conditioning. I hereby certify that I am
in proper physical condition to participate.

Signature:____________________________ Guardian if under 18: ____________________________________
Make checks payable and mail to: Rockdale Special Olympics, 310 Cambridge Way, Covington, GA 30016.
Race will proceed rain or shine. For more information call
Erika Sellers at (770) 833-0907 or erikaesellers@comcast.net
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re8eglsLrauon lee / Aer 3/3/14
1 mlle $20 $23
3k $20 $23
lamlly of 4 $70 $80

______ 1 mlle
______ 3 k
______ Sponsor Special Olympic Athlete
T-Shirt Size (Circle One)
Youth Small
Medium
Large
X-Large
Adult Small
Medium
Large
X-Large
XX-Large ($2 extra)
Total $_________
Register by using the entry form below
Or on-line at
Presents the 3rd ANNUAL
ROCK ON ROCKDALE 5K
AND FUN RUN

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