Gussie Gallop 5K Run/Walk/1K Kids Run
Registration Form
Saturday June 21, 2008
St. Mary’s Church Parking Lot St. Augusta,
MN  

Each participant must fill out a separate registration form. Registration the day of the race will start at 7:00 a.m. No refunds. The 5K course is a flat loop with mile markers and intersections staffed.  1K kid’s fun run will begin at 8:15 a.m. and 5K run/walk at 8:45. Awards immediately after completion of the 5K. Race registration in the St. Mary’s church parking lot on Main Street.  

Name ______________________________________________________________________  

Address____________________________________________________________________

City __________________________________  State___________________ Zip___________  

Phone _______________________________      ________ 5K Run/Walk  

Sex _______   Age _________                           ________ 1K Kids Fun Run for Ages 5-10  

Date of Birth _____________________  

Adult Shirt Size (Please Circle)   S     M     L     XL     XXL           

Child Sizes: (Please Circle)   Small 6-8    Medium 10-12    Large 14-16  

I know that running is a strenuous activity and potentially hazardous. I am medically able and properly trained. I am entering the event at my own risk and am responsible for any injuries I may incur as a result of participation in this event. I agree to abide by the decisions of the race officials and not hold any race official or any organization associated with the race responsible for injuries incurred as a result of this event.
For safety reasons no pets, strollers, bikes or rollerblades will be allowed on the course.
 

Signature of Participant ___________________________________________ Date __________

                                      (Signature of Parent if under 18 years old)  

T-shirts guaranteed to all participants registered by June 14, 2008. T-shirts to late entrants or day of race entrants while supplies last. Refreshments available at the finish.  

5K Run/Walk $12 if received by June 7, 2008
$15 after June 7th and day of race  

1K Kids Run $8 if received by June 7, 2008
$10 after June 7th and day of race  

1K Kids Run – awards to all finishers

5K Run – awards to top three finishers in each age division for male and female

19 and under     20-29    30-39    40-49    50-59    60-69    70 and over  

Make checks payable to SMHOC and send with completed entry form to:

Tony Laudenbach 23596 Gaberdine Road St. Cloud , MN 56301