3rd Annual

I Run This Town

5K

AND1MILE FUN RUN

SATURDAY, MAY 9, 2015 AT 8:30 A.M.
@ CLAY CITY ELEMENTARY SCHOOL, CLAY CITY, ILLINOIS
[5K AND 1 MILE WALKERS WELCOME!]
Proceeds will help purchase student incentives for the PBIS program.

PREREGISTRATION/REGISTRATION FEE:
If entry forms received on or before April 24:
5K: $20
for 1 Mile
If entry forms received after April 24:
5K: $25

1 mile: $5

*No shirt provided

1 mile: $10

Same Day Registration Available

FINAL registration @ Clay City Schools @ 7:00 AM the day of the race and closes at 8:15 AM
All events begin at 8:30 AM outside the Clay City Schools; courses close at 10:30 A.M.
Those pre-registered on or before April 24 for the 5K events are assured of receiving a short-sleeve Tshirt. Extra shirts will be ordered but will be available only while supplies last to those registered after
April 24.
*1 mile Participants may order a cotton t-shirt (please add $5.00) on or before April 24.

EVENT:
AGE CATEGORY (CIRCLE ONE):
_____ 5K
11 & under;
12-15;
16-18;
19-24;
25-34;
35-44;
45-54; 55 & older
_____ 1 MILE FUN RUN
All Fun Run Participants will receive a Ribbon
PLEASE CIRCLE YOUR T-SHIRT SIZE. IF NOT MARKED, YOU WILL RECEIVE A MEDIUM.
YOUTH SIZE:
SMALL
MEDIUM
LARGE
ADULT SIZE:
SMALL
MEDIUM
LARGE
X-LARGE
*XXL *ADD $2

NAME_______________________________________________________________________________
_________________________________________________________
_________________ ______
ADDRESS

CITY

STATE ZIP

EMAIL ADDRESS

AGE ON DATE OF RUN GENDER

Waiver: By signing below, I do hereby release and discharge from

liability the Clay City Schools and the Village of Clay City, organizers,
event sponsors, supervisors of the I run this town run and their
representatives, successors and assigns for any and all causes of
action, claims, and injuries suffered by me in this event, however
incurred. I attest and verify that I have sufficiently trained for the
completion of this event. As a parent or guardian of the applicant (if
applicant under the age of 18), I hereby consent to the participation of
the applicant in the race under the above mentioned conditions.
Signature______________________________________________________________________
__________________________ Date_________________
Parent/Guardian______________________________________________________________
__________________________ Date_________________

MAKE CHECKS PAYABLE TO: CLAY CITY SCHOOLS

MAIL ENTRY FORM TO: CLAY CITY SCHOOLS, ATTN: PBIS RUN, PO BOX 542, CLAY CITY, IL 62824
OTHER CONTACT INFORMATION: lmiller@claycityschools.org OR CALL (618) 444-9090 OR FACEBOOK PAGE: I RUN THIS TOWN. CLAY CITY 5K