2015 VBC Fun Run Form

Viking Booster Club Fun Run / Walk
Sunday, June 28, 2015
Meet at the Football Field / Track in Bertrand
Registration at 7:30 a.m.
Race Begins Promptly at 8:00 a.m.
Official Entry Form (may be duplicated)
One entry per person. Please complete all sections, SIGN & return this form with entry fee to:
VBC Fun Run / Walk
c/o Trista Newcomb
103 Medina Avenue
Bertrand, NE 68927
Make checks payable to Viking Booster Club
Entry fee is non-refundable.
Contact: Trista Newcomb at 308-472-5327
cnewcomb1@frontiernet.net
PLEASE PRINT:
Last Name
First Name
Address
City
Age
State
E-Mail Address
M
Gender
F
Zip
Phone
Event (Mark One):
5K Run
2 Mile Run
2 Mile Walk
1 Mile Race (for ages 10 & Under ONLY)
Entry Fee: $20.00
Age Division (as of 6/29/14, Mark One):
10 & Under (1 Mile Race Only)
15 & Under
16 - 19
20 - 24
25 - 29
30 - 34
35 - 39
40 - 49
50 - 59
60 & Over
Register by Friday, June 12th to be guaranteed a T-shirt. Participants who register
after June 12th are not guaranteed a T-shirt.
Medals will be awarded to top male and female participants in each age division in each event listed above.
T-Shirt Size (Circle One):
Adult Size: Small
Youth Size:
Small
(T-Shirts are guaranteed only to those participants who register by June 12th!)
Medium
Large
X-Large
Medium
Large
X-Large
Waiver: (Parent or Guardian must sign if entrant is under age 18.) I hereby waive & release all rights & claims for damages
I may have against the organizers & sponsors of the Viking Booster Club Fun Run / Walk event to be held on Sunday,
June 28, 2015, for any & all injuries suffered by me in this event. I hereby authorize the organizers & support personnel
of the Viking Booster Club Fun Run / Walk event to obtain any appropriate medical aid I may require during this event.
I hereby grant permission for the use of my name and picture to be used in publicity or promotional materials and
media coverage of the Viking Booster Club Fun Run / Walk event.
Signature
Date