Gaslight Gallop 5K Race/Walk
First Friday, August 5, 2016
WELLSBORO, PA
Start Time: 6:00 p.m., Registration opens at 5:00 p.m., Packer Park Community Center, 3 Queen St, Wellsboro
Entry fee: Individually $15 by July 22nd; $20 race day; Family (4 or more) $45.00, $60 race day
(Shirts guaranteed to pre­registered runners/walkers.)
Awards: Top Male and Female Overall, top two men and women in each age group. Course: Start and end at Packer Park. A modestly challenging course through the streets of Wellsboro. 1 MILE FUN RUN FOR BEGINNING RUNNERS/WALKERS
Course: Packer Park to Wellsboro Cemetery and back. Fee: $5.00
(First Place Medal/Participation ribbons)
Make check payable to: WHS Volleyball.
Send entries to: Michelle McNett, 29 Woodland Ave, Wellsboro, PA 16901
Detach and return
Name: ___________________________________________________
Address: _________________________________________
Age on race day:_______
City/State/Zip: ______________________
Email: ______________________________________ T­shirt: _____ S ______ M ______ L _____ XL
Gender: ______________________________
(Please indicate youth or adult size)
Age category: Age 19 and under Age 20­29 Age 30­39 Age 40­49 Age 50­59 Age 60 and up
Release and Acknowledgement of Gaslight Gallop
In consideration of the acceptance of my entry, and intending to be legally bound, I hereby, for myself, my heirs, my executors and administrators, do waive release, and discharge all rights and claims which I may have, or which hereafter accrue to me, against Wellsboro School District, Wellsboro Borough, all named and unnamed sponsors and volunteers, while traveling to and from event, participating in the event, using any and all facilities, for any and all injuries suffered by me in this event. I understand that my part in this event can result in injury to myself and property. I hereby attest and affirm that I am medically able, equipped and properly trained for this event.
Media Release (please check)
________ I give permission for my name and picture to be released to the media.
Signed: _________________________________________________
Date: ____________________
Signed: __________________________________________ (Parental Signature necessary if under 18)
Proceeds benefit the WHS Volleyball Team.