Wythe Striders |

Belview Pumpkin Run

5k Run/Walk and Children’s Fun Run

Signature of parent or guardian if under 18 years of age. Date

address_____________________________________________

Please mail and make

checks payable to:

Race:

_____5k run _____1 Mile

_____5k walk _____100 Yard

One form per registrant please.

BES PTA

Attn: Pumpkin Run

3187 Pepper’s Ferry Rd.

Radford, VA 24141 Phone

Name

Address

Adult T-shirt size: S M L XL

Youth T-shirt size: S M L

Age on Race Day _________

Sex M F

Signature Date

Waiver: To participate in the Belview Pumpkin Run, I do hereby release and

discharge The Belview Pumpkin Run, The Belview Elementary School PTA,

Montgomery County Schools, The Town of Radford, Radford Parks & Recreation,

their agents, officers, employees, subsidiaries and affiliates, all sponsors, and all

those persons involved in organizing and conducting this event from all claims,

demands, losses, damages, actions, cause of action or suits of whatsoever kind or

nature, arising from my participation in the Belview Pumpkin Run on October 24,

2009. I realize that some of the activities may subject me to hazards not all of which

can be foreseen. I desire and consent by signing this form to take part in all such

activities. Furthermore, I also agree that I have appropriate health care coverage

for this activity and I understand that there would be no reimbursement for medical

expenses incurred from this race. I grant permission for Belview PTA to use my

photograph or name for publication regarding this event.

Overall and age group awards

for top two male/female

finishers in each 5k run

division: 14 & under, 15-19, 20-

29, 30-39, 40-49, 50-59, 60 +

Walkers: Trophy for top

finisher

PRIZES

Drawings will be held

for valuable gift

certificates, prizes, &

more!!!

There will be a variety of

drinks and snacks at the

finish.

For more info

contact:

Amy Heinline at

aheinline@msn.com

or

Julie Mullens at

jmmullens@verizon.net

Time: 9:30 AM

Date: 10/24/09

Place : Bisset Park, Radford,VA

5K Entry Fees:

•$15 and includes a T-shirt for first 100 runners pre-registered by

October 15, 2009.

•$20 race day registration

Fun Run Entry Fees:

•$5 and includes a T-shirt if pre-registered by October 15, 2009

•For ages 12 & under, ribbons to all finishers

•A 1 Mile or 100 Yard option available

•Will begin immediately after 5k event

Proceeds will benefit the

educational needs of Belview

Elementary School students.

The Course: All races begin inside Bisset Park near

Shelter #2. The 5k course is level and proceeds along

The Riverway. The 5k walk is the same course as the

5k run. Strollers are allowed on the 5k course. Every

mile will be marked. Water will be available near the

halfway point of the 5k.

The 2nd Annual

Registration: Opens at 8:00 am at Shelter #2 in

Bisset Park. Race packets may be picked up from

8:00 to 9:00 am on race day for 5k participants. Children

.s Fun Run race packets may be picked up from

9:15 to 10:00 am. 5k participants please plan to arrive

before 9:00 am to avoid road closure for event.

A rain or

shine event!