18th Annual Chamber 5K Wall~lRun

Sat. June 25, 2011 8:00 am

On the Square in Versailles I

Registration: $10 if postmarked by 6/2lfl11 (includes at-shirt)

$15 race daY (includes a e-snlre), vou can register race daY
from 7:00 am to 7:50 am in front of the SChuerman Law
firm building (former "Ripley County Chamber Of Commerce
Office) on the East side Of the square.
Age Groups: <Runners and walkers) 13 and under, is-v: 19-29, 30-39,
lfO-lf9, 50-59, 60 and over. TOp 3 in each age group (male and female)
will receive a gOld, silver, or bronze medal.
Be Sure to StiCK Around for Door priZes!

omCAL ENTRYfORM
Name _
Address _
City, State, Zip _
Age (6/25111): Sex: M F T-Shirt size: S M L XL CirCle Qne: Run Wall"
MaKe CheCKpayable to: "Ripley County Chamber Of Commerce
p.O. 'Box 576
Versailles, IN lf70lf2
Any Questions call: 812-689-665'1 or email: ripleYCC@ripleYCoUntYChamber.org
Waiver (must be signed to participate): In consideration Of the acceptance of my entry, 1 hereby waive,
disCharge, and release on behalf of my heirs, executors, and assigns, all claims of any nature arising from mY
participation in the "RiPleyCounty Chamber 5 K Run!WalK and do hereby release the "RiPleyCounty Chamber
of Commerce, and all sponsors, uiorxers, officials, and VOlunteers. 1understand the riSKSinVOlved for
partiCipating in sucn run/walK and have trained adequatelY in preparation. 1give the "RiPleyCounty Chamber
of Commerce permission for use of my name and/or photograph for partiCipating in this event for publicity. I
have noted any medical conditions betoui.
Signature Parent Signature (if under 18) ----c--------
In case Of Emergency Please Contact Phone _~ _