MOUNT JEWETT, PENNSYLVANIA

PLENTY OF DOOR PRIZES

ONE OF THE AREA'S BEST ROAD RACES "COME SEE WHAT IT'S ALL ABOUT"

PLAN ON COMING TO OUR POST PICNIC AFTER THE RACE FESTIVITIES

YOU’LL BE RUNNING THE BACK STREETS OF MT. JEWETT

SAME COURSE AS IN 2010. MORE FLAT, LESS HILLY

EACH YEAR WE MAKE A $100 DONATION TO A CHARITY OF OUR CHOICE

$10 ENTRY FEE INCLUDES T-SHIRT, PICNIC, DOOR PRIZES AND

AWARDS PRESENTED TO THE FIRST AND SECOND MALE AND FEMALE IN THE 5K

AGE GROUP CATEGORIES, OVERALLS FOR FUN WALK AND RUN. REGISTRATION AND CHECK IN FOR ALL 5K / WALKERS / 1 MILE RUN WILL BE 7:30 TO 8:45 AM AT “MY SISTER'S PLACE”(STARTING POINT OF THE RACE) ON RACE DAY

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I HEREBY FOR MYSELF, HEIRS, EXECUTORS AND ADMINISTRATORS WAIVE AND RELEASE ANY CLAIMS I MAY HAVE AGAINST MT. JEWETT BOROUGH,

OFFICALS OR ANY INVOLVED SPONSERS. IN ADDITION, I ATTEST AND VERIFY THAT I HAVE FULL KNOWLEDGE OF THE RISKS INVOLVED IN THIS EVENT AND THAT I AM PHYSICALLY FIT AND TRAINED SUFFICIENTLY TO PARTICIPATE IN THIS EVENT.

5K RUN____ 2MILE WALK____ 1 MILE RUN____

**THE BELOW MUST BE COMPLETED, PLEASE PRINT**

SIGN______________________________SEX_________

NAME_____________________PHONE_____________

FULL ADDRESS_________________________________

SHIRT SIZES ADULT MED__ LG___ XLG___ (CHECK ONE)

AGE CATEGORIES: 18 & UNDER__ 19 TO 29___ 30 TO 39__ 40 TO 49____FEMALE 50 & OVER___ MALE 50 to 59____ 60 & OVER___

MAIL TO: BOB SWANSON 5K RUN C/O SCOTT SMITH

BOX 306 MT. JEWETT, PA 16740

PHONE: 814-778-5399 OR 814-778-5940 WWW.BOBSWANSON5K.COM KIRBYP@VERIZON.NET