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Foundation
Spring Into Health
5K/10K & Fun Run
Saturday, April 22, 2017
Lewis County General Hospital
REGISTRATION INFORMATION * PLEASE CONSIDER ONLINE REGISTRATION AT RUNSIGNUP.COM *
5K Walk/Run -$25 Includes race, raffle entry, and a T-shirt to those registered by April 14th.
Registration fee is $30 on race day.
5K/10K Medals will be given to the 1st place walker/runner in each age/gender category.
Fun Run-Free for children ages 3-10.
Registration Check-In from 8am until 9am. (Dialysis Lobby of LCGH)
The 10K Race starts at 9:00 am. The 5K Race starts at 9:30 am.
The Fun Run starts at 9:45 am. Children need to be checked in by 9:30 am.
Please note: Supervision of children will not be provided during the 5K event.
ENTRY FORM
Name:_____________________________________________ Address: __________________________________
State/Zip: _________________________________________ Phone: ___________________________________
Email: _____________________________________________ Gender: (Circle One) Male Female
Age Group: (Circle One): Under 10 11-20 21-30 31-40 41-50 51-60 61 & Over
5K Walk $25 Pre-Registration T-Shirt Size: S M L XL 2XL
5K Run $25 Pre-Registration T-Shirt Size: S M L XL 2XL
10K Run $25 Pre-Registration T-Shirt Size: S M L XL 2XL
Note: $30 Registration on the Day of Event, no shirt guaranteed
Fun Run (FREE)
Extra T-Shirt ($10) T-Shirt Size: S M L XL 2XL
Total Enclosed $ ___________________
Please make checks payable to: Lewis County Hospital Foundation and mail completed
forms to: 7785 North State Street, Lowville, NY 13367. For additional information, please
contact the Hospital Foundation at 315-376-5110 or jrhubart@lcgh.net.
Note: All 5K/10K and Fun Run participants must complete and sign and an acknowledgement
of risk and accident waiver and release of liability on the back of this form prior to the race.
Lewis County Hospital
Foundation
Spring Into Health
5K/10K & Fun Run
Saturday, April 22, 2017
Lewis County General Hospital
DATE: ____________________
ADDRESS: _________________________________________________________________________