Fairmount United Run Walk Memorial Day Monday May

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                                                                          FAIRMOUNT UNITED MEMORIAL DAY 5-K ENTRY FORM
                                                                                      MONDAY, MAY 30, 2011
  Fairmount United 5-K Run Walk                                                                                 9:00 AM
         Memorial Day                                                   5-K Run Walk for all ages begins and ends on
      Monday, May 30, 2011                                              the Square in downtown Fairmount, GA. 30139
                         Start and Finish Line                                                            ONE
                                                                                                 COMPLETE ONE FORM FOR EACH RUNNER
The Run starts and finishes on the Square in Fairmount.                 ENTRY FEES:

                                                                        5-K Early Registration             $15.00________ all ages
                       Directions to the Fairmount
From I-75 go East at Exit 312 on Hwy. 53 for approximately 15 miles.    Race Day                            $20.00________
At the intersection of Hwy. 53 and Hwy 411 turn left, go one block to   T-Shirt Size                        ADULT ___S___M ___L___XL ___XXL ___XXXL
the square.
                                                                                                                               Add $1.00 for XXL or XXXL
                          Race Day Activities                                                               YOUTH ___S___M___L
Fairmount United Memorial Day Festival 9:00-4:00 on the Square in
Fairmount. Open Antique Car Show, Chili Cook-off, Cake Walk, Horse
and Wagon Rides, Motorcycle Ride, Antique Tractor Rides, Crafts,        ADDRESS_______________________________________________________________________
Food, Fun Activities for Children, and More                             CITY__________________________________________ STATE______ZIP___________________

                Race Day Registration                                   PHONE (        )_______________________ AGE ON RACE DAY* _______MALE____FEMALE____
Late Registration will be available on race day beginning at 8:00 AM.   E-MAIL__________________________________________________________________________

                                                                                                                  WAIVER MUST BE SIGNED
Proceeds benefit United Way of Gordon County                            In consideration of the acceptance of this entry, I hereby for myself, my heirs, executors,
                                                                        administrators, and assigns, release and discharge all sponsors, organizers, promoters,
                                                                        directors, or person connected with the run from any and all claims for damages suffered by
                                                                        me as a result of my participation in or traveling to or from said event. I further agree that
                                                                        the above mentioned sponsors, organizers, promoters, directors, or persons connected with
                                                                        the event are under no obligation to provide physical examination or other evidence of my
                                                                        fitness to participate in such event . NO REFUNDS. Race held rain or shine.

                                                                        RUNNER’S SIGNATURE_____________________________________________
                                         Of Gordon County               PARENT/GUARDIAN_______________________________________________

                                                                                                                            (IF RUNNER IS UNDER AGE 18)
                                                                        On-Line registration available at or Detach and
                                                                        mail with entry fee payable to : United Way P.O. Box 486 Calhoun GA.
                                                                        30703 706-602-5548 or

                                                                                                   Certified Course
                                                                                                 USATF # GA 10032WC

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