Monroeville Area YMCA

15 Annual Mockingbird Classic

Choose Your Distance
Certified 8K, 5K, 1 Mile Fun Run
th

Date & Time:

Saturday, April 12, 2014
@8:00 AM
Fun Run will start @ 9:30 AM

Entry Fee:
th
Thru April 11 :
$20.00 (8K/5K)
$10.00 (1 Mile Fun Run)

Location:
Monroeville Area YMCA
2197 S. MT. Pleasant Ave.
Monroeville, AL 36460

Race Day
$30.00 (8K/5K)
$20.00 (1Mile Fun Run)
Awards:
Top Male and Female Overall 8K/ 5K
Top Male and Female in each age group 8K/5K
Age Groups:
14 and under, 15-17, 18-35, 36-49, 50 and Over.

Registration:
Register online @
Active.com or imathlete.com
Or
Monroeville Area YMCA
Make all check payable to:
Monroeville Area YMCA

First Name: _______________________________________ Last Name: ______________________________________________

Address: _____________________________________________________ City: ________________________ State: _________
Gender: ________ DOB: ________/_________/__________ Age: ____________________
Cell: ______________________________________ Email:
_________________________________________________
Method of Payment (Circle one): Cash or Check
Circle one of the Following:
Shirt Size (Circle one):

8K

5K

1 Mile Run

YS

YM
YL
S
M
L
XL
XXL
Children under 18 Years Old Please Have Parents Consent.
Signature_________________________________________ Date________________________________________
Parent / Guardian _____________________________________________________________________________
I do hereby give my permission to be treated by and duly licensed medical personnel in the event that I become ill or injured while participating in the Monroeville
are YMCA programs, and hereby agree to fully and completely indemnify and hold harmless the Monroeville Area YMCA, and all of its officers, agents and employees.
Together with all officers and adult supervisors of the Monroeville Area YMCA programs from and against any and all claims, demands, suits, debts, and causes of
action any nature whatsoever arising from or out of personal injury sustained while participating in any Monroeville are YMCA program period.

______ I hereby affirm I am not covered by personal insurance policy

______ I hereby affirm I am covered by personal insurance policy
Insurance Company: ___________________________________________

Signature: ___________________________ Date: ________________________