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PASC
P.O. Box 486
Pulaski, WI 54162
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Register To
SPONSORSHIP OPPORTUNITY:
There are many different ways you and/
or your company could sponsor this year’s
PASC Polka Trot. If interested in sponsoring the
Polka Trot, please return this page or contact us
at pascswim@gmail.com.
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Cash
Gold
Silver
Bronze
$__________
$1,000
$500
$250
These sponsors receive name/logo on t-shirt and
on PASC’s website for one year.
q Gift Card
q Door Prize
q Other_________________________
8:30AM 5K RUN/WALK (Chip Timed)
9:30AM FREE KIDS’ RUN
(¼ mile run—ages 4—9)
PULASKI MIDDLE SCHOOL
All proceeds from this event benefit:
Thank You for your support!
WEBSITE: SWIMPASC.ORG
E-MAIL: pascswim@gmail.com
The Polka Trot 5k run/walk will once again
be held during the Pulaski Polka Days’
celebration. We chose a 5k run/walk as our
club fundraiser not only because it is a healthy,
exciting event but also to encourage families
to participate together. Last year we had over
200+ runners/walkers participate and we are
hoping for even more this year! All proceeds
from this event will benefit the Pulaski Area
Swim Club.
The Pulaski Area Swim Club has over
70 members from Pulaski and surrounding
areas ranging in age from 5 years through
high school.
DATE: SATURDAY, JULY 19, 2014
REGISTRATION:
TIME:8:30AM 5K RUN/WALK
PRE-REGISTER BY: Thursday, July 10, 2014
w/t-shirt .........................................$20.00
Day of Event: w/t-shirt......................$25.00
No t-shirt register anytime.....................$15.00
Kids’ Run......................................... FREE
ADULT T-SHIRT SIZE:
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(chip timed)
9:30AM FREE KIDS’ RUN
(¼ mile run—ages 4—9)
PLACE: PULASKI MIDDLE SCHOOL
911 S. St. Augustine St.
Pulaski, WI 54162
(North on Hwy 32 to roundabout,
Crest Drive to St. Augustine St.)
PACKET PICKUP & LATE REGISTRATION:
5—7pm Friday, July 18
at Pulaski Middle School
Morning of Trot at Pulaski Middle School
7—8am Saturday, July 19
AWARDS:
Age Groups: (10 & under); (11—14);
(15—19); (20—29); (30—39); (40—49);
(50–59); (60—69); (70 & over)
Graphic Design By:
Michelle M. Eron
All proceeds from this event
benefit the
Pulaski Area Swim Club.
• Medals for all kids’ run participants
• Drawings for door prizes
• Silent auction at conclusion of the race.
•Pulaski Polka Days’ events including:
craft fair and great “live” polka music
on the Polka Days’ grounds & Zielinski’s
Ballroom all weekend.
In consideration of acceptance of this entry in the Polka Trot 5k, I hereby freely agree, for myself, my heirs, executors and administrators, to waive, release and
discharge all rights and claims which I may have against the sponsors of the event, organizer and promoter, the land owners, any and all contributors and any and
all workers, whether paid or voluntary, for any and all damages which may be sustained by me or my family, directly or indirectly in connection with my participation
in, or travel to or from the event. I agree to personally inspect all the race facilities and will refuse to participate if I am not satisfied with the safety thereof. WI STAT
895.525(3)(4) “a participant in recreational activities…accepts the risk inherent in the recreational activity of which the ordinary prudent person is or should be
aware.” I also hereby grant permission to use any photographs, motion pictures videotapes or any other record of the event for any legitimate purpose.
(age on race day)
SIGN UP:
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10 & under
11—14
15—19
20—29
30—39
40—49
50—59
60—69
70 & Over
CIRCLE GENDER
male
male
male
male
male
male
male
male
male
female
female
female
female
female
female
female
female
female
MAKE CHECKS PAYABLE TO: PASC
LAST NAME:__________________________________
FIRST NAME:_________________________________
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DATE OF BIRTH:_______________________________
CITY:________________________________________
STATE: ________________ ZIP CODE:___________
E-MAIL:______________________________________
PHONE NUMBER:__________________________
If participant is under 18, parent or guardian must sign:
SIGNATURE OF PARENT OR LEGAL GUARDIAN:
____________________________________________
DATE:________________________________________
MAIL REGISTRATION TO:
PASC • P.O. Box 486 • Pulaski, WI 54162