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REGISTRATION FORM - Wrightsville Beach Museum of History

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									                                                     THE WRIGHTSVILLE BEACH
                                                       MUSEUM OF HISTORY’S
                                                  SECOND ANNUAL JINGLE BELL RUN
                                                   SATURDAY, DECEMBER 18TH, 2010
                                                           AT 9:00 AM

In celebration of the Meyer Cottage’s 100th anniversary, The Wrightsville Beach Museum of
History invites you to participate in the museum’s Second Annual 5K Jingle Bell Run. As this
will be a celebratory, holiday event, race participants are encouraged to dress in holiday apparel
(i.e. Santa costumes, antlers, snowmen etc.).
Location: Wrightsville Beach Museum of History, 303 West Salisbury Street, Wrightsville Beach, NC
Race Day Schedule: 7:30 Check in begins at WB Museum
                     8:45 Registration closes
                     9:00 Race starts (walkers will follow the runners)

Safety: To ensure the safety of all participants we must prohibit bicycles, headphones, skates and skateboards.
Dogs are also prohibited.

Race Course: The 5K course will take participants around the John Nesbitt Loop and will include a short run
             up North Channel Drive and back. The race will begin and end at the Wrightsville Beach
             Museum of History on Salisbury Street. Runners/walkers are responsible for becoming familiar
             with the race course. Timing by Brunswick Timing.
Parking:     Free parking at Town Hall, grassy area near old WB Fire Department, and Wrightsville Beach
Rest Rooms: Restrooms are located next to the tennis courts.
Race Packets: Packets will be available for pick up at the Wrightsville Beach Museum on Salisbury St. (Hwy.
             74) on Friday, December 17th from 3 – 7:00 p.m. and on race day from 7:30 -8:45 a.m.
T-shirts:    T-shirts to the first 300 participants. Limited quantity and sizes, so please specify size on entry
Age Groups: Male and Female: 9-12, 13-19, 20-29, 30-39, 40-49, 50-59, 60 and over. Awards will be given
             for each age group and overall.

Awards:        1st, 2nd, and 3rd overall male and female

*** Entry fee includes jingle bells and t-shirt to the first 300 registered participants and post-race refreshments
                                                          at end of race ***

                                                                    REGISTRATION FORM
                                       NAME ______________________________________________________
                                       E-MAIL _____________________________________________________
                                       TELEPHONE ________________________________________________
                                       MAILING ADDRESS__________________________________________
                                       CITY ________________________ STATE _______    ZIP _________
                                       GENDER_______________ AGE AS OF 12/18/10 __________________

                                       CIRCLE ONE:                          5K RUNNER                           LOOP WALKER

                                       T-shirt Size / Circle one: S                      M      L     XL
                                 No size marked means Large. No size exchanges
             ** Parent or guardian must sign for entrant under 18 years of age.
Adult Entry Fee:                    Postmarked before Friday, Dec.3rd ……….. $20
                                    After Dec. 3rd ................................................ $25
12 and Under:                       Postmarked before Friday, Dec.3rd.............. $15
                                    After Dec.3rd................................................... $20

                          Entry fee is non- refundable and non-transferable.

Checks – payable to Wrightsville Beach 5K Jingle Bell Run and return with completed form to:

Wrightsville Beach Museum of History
P.O. Box 584
Wrightsville Beach, NC 28480

Credit Cards – please fax completed form to 910-256-0793
Circle Card of Choice:     Visa Master Card

Card Number________________________________ Expiration Date _________________

Signature____________________________________ Date: _________________________

                                                       Waiver and Release
In consideration and acceptance in the Wrightsville Beach Museum of History’s 5 K Jingle Bell Run, I, my heirs and my assigns
waive any and all claims to which I may become entitled and hereby release the Wrightsville Beach Museum, all other organizations,
sponsors, representatives, their agents and employees and any other persons assisting in putting on the event from any and all claims
for damages or injury incurred by me as a result of my participating in or traveling to or from this event. I further state that I am in
proper physical condition to compete in the run. I also give my permission for the free and unrestricted use of my name and picture in
any broadcast, telecast or written account of the event. Parent or guardian must sign if under 18 years of age.

Print Name ____________________________________________________________________________

Relationship to participant if under 18 ______________________________________________________

Signature _______________________________________________________Date __________________


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