Tuscaloosa Track Club - Certified Course

Hospice of West Alabama’s

4th Annual Family 5K Walk/Run

Saturday, March 9, 2013

 8:00 a.m. (certified course)

Registration begins at 7:00 a.m.

Registration at Willow Pavilion at Munny Sokol Park

5K will be held at Munny Sokol Park

Proceeds benefit Hospice of West Alabama

AWARDS

~ Overall Male and Female-Top 3 ~ Grand Master (50+) Male and Female ~Masters (over 40) Male and Female (1st only)  

Top 3 in age groups Male & Female: 9 & under, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70 & over; physically challenged 

REGISTRATION

$20.00 (first 150 registrants get a free t-shirt!)

Make checks payable to:

Hospice of West Alabama

Please contact our office: (205) 523-0101

Mail to: Hospice of West Alabama – Family 5K, 3851 Loop Road, Tuscaloosa, AL 35404 

Pick-up pre-registration bags at one of the following: 

                           Athlete’s Foot-M­idtown Village: Friday, March 8^th between 4p.m.-7p.m. 

                                                    or the day of the race at Munny Sokol Park 

Name: _________________________________

Address:­­­­­­­­­­­­_________________________________________________ 

City: _________________________ State: _______ Zip: ______________

E-mail_________________________________ Shirt: S  M  L  XL  Sex: M F

Age: ________ (as of 01/30/12)  D.O.B.:     /   /    

Physically Challenged:  Y   N    Tuscaloosa Track Club Member?  Y N

I, individually, (and/or as parent, and/or guardian of the named minor) for and in consideration of acceptance of this entry in the

aforementioned event, do hereby release, remise, waive, and forever discharge the Sponsors, The Tuscaloosa Track Club and any and all other

supporting groups of this said racing event, together with all of their officers, agents, officials and employees from any and all liability, claims,

demands, actions or cause of action whatsoever arising out of, or related to any injury, illness, loss, or damage, including death, relating to

participation in the aforesaid event. I further state I am in proper physical condition to participate in this event.

Signature:­­­­­­­­­­­­­­­­­­­­­­­­­__________________________________ DATE:_______________

(Parent or Guardian for entrants under 18)

*Every 5K participant must complete a registration form. Forms with multiple registrants cannot be accepted.