Individual Registration Form - Humane Society of Marathon County

Individual Registration Form
Name:_______________________________________________________
Age:____________
Gender: (Circle One)
Male
/ Female
Shirt Size: (Circle One)
Women’s
Men’s
Youth
S
S
S
M
M
M
L
L
L
XL
XL
XXL
XXL
**Shirts are dry fit performance shirts
□
Yes! I am participating with my dog!
Dog’s Name:__________________
Address:______________________________________________________
City/State/Zip:_______________________________________________
Run For Their Lives!
5K Run/Walk
Date: Saturday, May 30th, 2015
Location: Doepke Park,
Rib Mountain, WI
*Benefiting the Humane Society of Marathon County
Time: Registration: 7:30 to 8:30 am
9:00 am Chip timed 5K start
***Participants accompanied by dogs will start behind competitive
runners.
Phone:________________________________________________________
E-mail:________________________________________________________
Please include my e-mail in future correspondence regarding the race and other
fundraising events from the Humane Society of Marathon County: Yes / No
I do hereby release and hold harmless the Humane Society of Marathon
County 5K Run/Fun Walk, including all organizers, sponsors, volunteers,
and property owners from any and all liability resulting from my participation
in this event for any reason. I understand that I, or my dependent, is
participating in said run at our own risk. I understand that my registration fee
is nonrefundable if the event is cancelled due to inclement weather.
Cost: $30 before May 15th, 2015
Signature:_____________________________________________________
**Teams of 4 or more $25.00 per person (use team reg. form)
$35 after May 8th, 2015
***Non-refundable if race cancelled due to inclement weather
Guardian Signature (If under 18):
___________________________________________________________________
Registration alternatives: Active.com or printable
registration brochure at www.hsmcrunfortheirlives.com
Timing: Professional timing provided by Performance Timing
Parking: available at South Mountain Elementary, 5400
Bittersweet Road, Wausau WI
Awards: will be distributed by age division
Please make checks payable to HSMC
Mail to: Humane Society of Marathon County
Attn: Mary Kirlin
7001 Packer Drive
Wausau, WI 54401
Proudly Sponsored by:
ausau, WI 5440
Run/Walk participants who register early will be provided a
performance dry fit t-shirt as well as post race refreshments.
*Please register before May 8th to guarantee
shirt availability.
Volunteers are welcome! If you would like to organize a
volunteer force for this race/walk please contact HSMC’s
Volunteer Coordinator for more information!
Wisconsin State Statute requires all dogs 4 months and older to be rabies vaccinated,
and 5 months and older to be licensed. If you are running with your furry friend, please
have his tags securely fastened to his collar or harness.
Central WI Animal Emergency Center * Briq’s Soft Serve * CoVantage Credit Union * BMO