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2: $20 10K&5K: $25
10K &

will help send 5o high school students to a "CIY" (christ In Youth) event this summer in Cleveland, TI{.

PruRncrsrnauoN/Rrcrsrna.rroN Frn:

If entry forms received on or before April If entry forms received after April 2:
Same Day Registration Available

5K:

1K: $5 .No shirt provided for 1K:

$5

lK

FINAL registration @ First Christian Church @ 7:00 AM the day of the race and closes at 8:15 AM
A11 events

begin at 8:30 AM outside the First Christian Church; courses close at i0:30 A.M.

April 2 for the 10K and 5K events are assured of receiving a short-sleeve Moisture Management T-shirt. Extra shirts will be ordered but will be available only while supplies last to those registered after April 2. 'lK Participants may order a cotton t-shirt (please add $5.00) on or before April 2.
Those pre-registered on or before

EVENT:

AGE

CATErcnv (CmCrr ONr):

10K 18 &under, 19-24, 25-34; 35-44; 45-54; 55 & older 5K 11 & under; 12-15; 16-18; 19-24; 25-34; 35-44; 45-54; 55 & older lKFunRun AllFunRgn Parricipants uJill receive aRibbon
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Apu[T

PTEASE CIRCLE YoUR T-SHIRT sIzE. IF

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LARGE X-lancu *XXL *m

NAME

ADDRf,SS

CTTy

STATE

ZTP

EMAIL

ADDRESS

,,

AGE oN DATE oT RUN

GENDER

Waiverl By signing below, I do hereby release and discharge from liability the First Christian Church and the City of Flora,
organizers, event sponsors, suprvisors of the '$illY SOCKSRID 2013' and thdir representatives, succssors and assigns for any and all causes of action, cliaims, and injuries suffered by me in this event, however incurred. I attest and verifu that I have sufffciently trained for the completion of this event. As a parent or guardian of the applicant (if applicant under ttre age of
1

8),

I hereby consent to the participation of the applicant in the race under the above mentioned conditions.

Signature-----

- Date--------

OrHER

MAKE CHECKS PAYABLI o: FCC RUN MArL ENTRy FoRM To: Fmsr CnRrsrnu CuuncR, Arr: FCC RUN, 100 W. 4"', FLoRA, lL 62839 CoNrACr rNFoRMArroN: www.fccflora.com oR CA]-L (618) 508-2755 oR FACEBooK PAGE: RIIN . . . FOR HEAVEN'S SAKE