ROC

sK Racn

/(Waricrns r Mtrr Euirr Rulr/ 4 Mrrr-4 MAT\r Rnray

Wurcous Fon sK aND 1 Mnr Evrmrs!!) Saturday, Augugt 24, LotS at 6:oo P.M.

THE DTOCK RUN * REI*ay

Clay County Courthouse, Louisville, Iliinois

Proceeds will help Organization for Autism Research (O-e-R.) via Bank of America Chicago llarathon zor3 Charity Team member ffelanie Pearce In conjunction with Louisvilles Block earty * Live Entertainment and Free Dinner (Louisville Rotary CIub setting &inls)

*Chip Timing Services by ChanrpionChip for SK & r l{jle Event* PREREGISTMTI0Tf/REGISTRATI0If FEES FOR sK & r ttlile

If entry forms

neceived on or before August

lf:

Same Day Registration

Available PREREGISTRA?I0I\I FEES FOR REtAy:

*Ifo Sarne Day RegiskaUon Available for

$rz SKr $zS r }Iile $rS

SK: $zo r

it{ile

*Ifo rcfunds due to weather

*Course closes 7oo P.lf.

4-IfAI{

TEAIII

FEE:

$6o.oo on or before August rg

Relay

*Relay will begin at approxirnately 54S p.m.

Pir{.

Final registration for 5K & r }Iile and Packet Pick-up begins outside the Cou{house at 4go Ptrf the day of the race and closes at 56o

dl those pre'registered by August rf are assured of receiving a .lfoisture lfanagement T-shirt. Extra shirts urill be orderd but rvil be available only while sqpplies last to those registered after August rgth Awards ceremony immediately following Relay

EVEIYT: 5( Rur

c.e.rtconr (crncu For SK,

orrt
I't
and 2"d Age Category lrfale/Female 55 & older

t(

Overall .l{ale/Female and

&

under, u-r5,

16-18; tg-24; zS-54; Tg-44; 41-yl;

r ltlrr Frn Rur

For r trfflg I't overall l{ale/Female

RE[ltY r* tty rgr ronowrr{c cATE@Rr[s: Au Frrce; Au tr{rue; I,tr,wto l[at.l/FEtraru (Co-zo); u & Urorn (ln rrmrns u yoA AIvD urorn); rS - rg ToA (ALL }frrrrns tg yoA AilD urorn); trfurs trfusftns (flcr UEUBER ulut, & 4o roe on ornen); Ftmre trf^e,srrns (racr rrmrn rruam & 40 yolon ororn)
Pulsr Nlnrn
cIRcIJ rouR T-sf,ItrT slz[. IF HoT
]TARKED,

you wtl.r ftrcEryE .a

llmruy.
f,ADD $2 TEAM NAMI

YOUTH

SIZE: SIfALT lr{EDIUff

IABGE

IDaLT SIZE:

SI{AII [rpIuu l..encr X-I.ancr *XXI.

Ir Rnurv,
& Trau l,LmAcrr

ANPRNSS

CITY

STATB

Z,IP

E,NIAIL:\DDRE,SS

PHONE

AGE oN DATE o}. RL1N

GENDER

Waiver: By signing below, I do hereby release and discharge from liabitity O.A.R., the City of Louisville, organizers, event sponsors, supervisors of the'BocE rxr BtocK RUN 4 BELaY- and their representatives, successors and assigns for any and all causes of action, claims, and iniuries suffered by me in this event, however incurred. I attest and verify that I have sufficiently trained for the completion of this event. As a parent or guardian of the applicant (if applicant under the age of 18), I hereby consent to the participation of the applicant in the race under the above mentioned conditions. Signature Dat-e ParentlGua Date
MAIL

Maxr CuEcxs P,lvAsrE ro: RocK THE BLocK RUN [oRM To: ATTN: Rocx r]rE BLocK RUN & Rrlilr, P.O. Box 190, Loursvrll-E, IL 62858 OR DRop orr Loulsvr LLE Crry HALL, LouISvILt-E, IL OTHER CoN'rAcr INToRMATIoN: psitr'_sg!,1n_q.trrn,-cs_,tt OR CALr. MELANIE PEARcE @ (618) 508-2755 F.qcEeoox PAGE: RocK THE Br-ocK RUN & REr.Ay Loursl,rr.r n Br ()cx P,lnrY
ENTRY

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