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ARACETOSAVELIVES

ARACETOSAVELIVES
ETOSAVELIVES
Benefitting Choices Pregnancy Resource Clinic
Saturday. November 9. 2013
BONA DEA TRAILS. RUSSELLVILLE, AR
5K Run/WALK, Family 1K, & Virtual Participants
Participants
RACE BEGINS @ 9 a.m.
child strollers
th welcome
$20Pre-RegistrationthatGUARANTEESyourt-shirtendsSeptember30 !
October1 st –23 rd :Registrationis$25.October24 th –RaceDay:Registrationis$30.
LastName:______________________________FirstName:___________________________________
Gender(CircleOne):MALEFEMALEBirthdate:_________________________Ageon11.9.13:________________
Address:_________________________________________Email:_____________________________
City:________________________State:_________Zip:____________Phone:_______________________
ShirtSizingInfo:AllparticipantsregisteredbySeptember30thareguaranteedashirt–Late/dayofraceregistrantsmayreceiveashirtwhilesupplieslast!
Adult:(circleone): S M L XL XXL Youth(circleone):X/S(2/4) S(6/8)M(10/12) L(14/16)
Event(circleone):5KRUN@9a.m. 5KWALK@9:05a.m. FAMILY1K(following5K)VIRTUAL5KPARTICIPANT
**RegistrationandCheck-
*RegistrationandCheck-Inwillbeginat8a.m.andendat8:45a.m.
Inwillbeginat8a.m.andendat8:45a.m.**
nat8a.m.andendat8:45a.m.**
**
th
EventFees: Allparticipants/virtualparticipantsregisteredbySept.
th
30st areguaranteedashirt!
rd
Children(12&Under):Pre-RegisterbySept.30 th:$10  Oct.1st–23rd:$15  Oct.24thth–Nov.9thth:$20
Teens/Adults(13&up):Pre-RegisterbySept.30 :$20  Oct.1 –23 :$25  Oct.24 –Nov.9 :$30
th
VirtualParticipants:Pre-RegisterbySept;30 :$20*virtualdonationsafterthisdatearenotguaranteedashirt.
Release:
I know that running/walking and volunteering to work in races are potentially hazardous activities. I should not enter and run/walk this race unless I am medically able
and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run/walk. I assume all risks associated with
running/walking and volunteering to work races including, but not limited to, falls; contact with other participants; the effect of the weather, including high heat and/or
humidity; the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and
in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Catch the Beat 5K, Choices Pregnancy
Resource Clinic, Bona Dea Trail, city of Russellville, ArkansasRunner.com, and all sponsors, their representatives and successors from all claims or liabilities of any
kind arising out of my participation in the event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I
grant permission to all the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose.
Signature:______________________________________________________ Date:_______________
Parent Signature (if under 18): _____________________________________ Date:_______________

PleasemakecheckspayabletoChoicesPregnancyResourceClinic,P.O.Box394Russellville,AR72811Forelectronicpayment,pleasefillouttheformbelowandreturnbymail,withregistration.
IrequestmybankorcreditcardcompanytomakeaONE-TIMEtransferof$____________.   
BankDraftInformation    Debit/CreditCardInformation
 
Checking(Attachavoidedcheck) VISA MasterCard DebitCard
Savings(Attachavoideddepositticket)Acct#___________________Exp.Date______/______
  
Date_______________________Signature___________________________________________
Pleasesendmenewslettersviae-mailaddress:_______________________________________
ChoicesPRC–P.O.Box394–Russellville,AR72811–479.967.2255(office)–479.498.4554(fax)–choicesprc.org
Date,Times,Location:
Date,Times,Location:
• Saturday,November9,2013
• BonaDeaTrail,Russellville,AR
• 5KRun/Walkstartsat9AM,1KFamilyRun/Walkimmediatelyfollowing
EntryFees:
EntryFees:
BySeptember30th
BySeptember30 October1st-23rd October24th-RaceDay
October24 RaceDay
• Children(12andunder):$10   $15   $20
• Teens/Adults(13andover):$20   $25   $30 
• VirtualParticipants: $20   $20   $20

Registration:
Registration: th
EarlyRegistration(throughSeptember30
EarlyRegistration(throughSeptember30
th
)guaranteesat-
)guaranteesat-shirt
shirt
LateRegistration(afterSeptember30 )mayreceiveat-
LateRegistration(afterSeptember30 )mayreceiveat-shirtaslongassupplieslast
• Online:www.choicesprc.org/events.html(Aprocessingfeewillbechargedthroughraceroster.comforcreditcards)
• ByMail:Sendcompletedformw/paymentto:ChoicesPregnancyResourceClinic,Inc.
P.O.Box394
Russellville,AR72811
• InPerson:ChoicesPRCoffice,311E.3rdSt.RussellvilleAR,72801
OfficeHours:Monday–Thursday8a.m.–4p.m.
• RaceDay:RegistrationwillbeavailablethedayoftheraceatBonaDeaTrailsinRussellville,ARfrom8AM–8:45AM
Refreshments:
Refreshments:
• Waterandotherrefreshmentswillbeprovidedduringandaftertherun
InclementWeatherPolicy:
InclementWeatherPolicy:
Theracewillgoonregardlessofprecipitation.Intheeventthatweatherconditionspresentanimminentdangerto
participants,theracewillbecancelled.Norefundswillbegiven.

ChoicesPRC–P.O.Box394–Russellville,AR72811–479.967.2255(office)–479.498.4554(fax)–choicesprc.org