WHAT RACE DAY INFO

5K Run / Walk (Approx. 3.1 miles) Registration time: 7:30- 8:30AM in the Dixfield Fire Station Start Times: Run - 9:00 AM Walk 9:15 AM

WHY
Danielle Dani Ranger was a vibrant and kind hearted young lady who lost her life 10/16/2011. She was an active member of the community as well as a Junior Firefighter and athlete. She had many loves and passions. Each year the funds from this race will go to support one of those passions.

ENTRY FEES
Pre-Registration Deadline: October 1, 2013 5K Run/Walk entry with a T-Shirt - $20.00 Kids under 12: $15.00
To be pre-registered your completed registration form must be received before October 1st, 2013.

ADDITIONAL INFORMATION
All proceeds from the 2013 Dani Ranger Memorial 5k Run/Walk will go local families of the River Valley that may be in need during the 2013 Holiday Season.

Please make checks payable to: Dani Ranger Memorial Fund Race Day Registration: 5K Run / Walk entry $25.00 Kids under 12: $15.00

WHEN
Sunday October 20th, 2013

WHERE
Dixfield Fire Company Station 38 Main St Dixfield, ME 04224

DONATIONS
If you would like to make a monetary donation please make your check out to: Dani ranger Memorial Fund Please mail checks to the address on the registration form

EVENT INFO CONTACT:

The 5K Run / Walk will commence at the DFC Station and travel back to the DFC station. For any question please contact Tammy Ranger: Tam-ranger@hotmail.com (207)357-9598 Jason Hyde: jaysun937@yahoo.com (207)418-7245 Joanne Leighton: (207) 897-6189

DANI RANGER MEMORIAL 5K RUN/WALK Registration Form

Male Please fill out a separate form for each family member Female

_________________________________________________________________________________________________ First Name (Please Print) Last Name

_________________________________________________________________________________________________ Address City / State / Zip Phone # Email

I will participate in the following event:

5K Run 5K Walk

WAIVER AND RELEASE STATEMENT (All

Athletes must read and sign)

T-Shirt Size (Orange only):

S M L XL XXL

OR Tank Top (White only):

S M L XL XXL
(Not available in youth sizes)

NOTE - Shirts are provided to all pre-registered participants. Those registering onsite October 20th, are not guaranteed a shirt or correct size.

REGISTRATION:
On-site Registration: $25.00 Pre-Registration: $20.00 (until October 1) Kids under 12: $15.00

I have read the accompanying event information and understand the policies of the event. I know that running and walking a trail/road race is a potentially hazardous activity. I should not enter unless I am medically able and properly trained. I assume all risks associated with my voluntary participation in this event, including but not limited to, falls, contact with other participants, the effects of the weather including extreme temperatures, traffic and all conditions of the road, all such risks being known and appreciated by me. Knowing these facts, and in consideration of your accepting my entry, I for myself, my heirs, executors, administrators, or anyone else who might claim on my behalf, covenant not to sue and WAIVE, RELEASE AND DISCHARGE the Town of Dixfield, all sponsors, race officials, workers or volunteers, their representatives, successors or assigns for ANY AND ALL claims or liability, whether foreseen or unforeseen, for death, personal injury or property damage arising out of, or in the course of my participation in this event. I further grant full permission to the above mentioned sponsors, organizers and or agents authorized by them, to use any photographs videotapes, motion pictures, recordings or other record of the event for any reasonable purpose. Signature of Participant (or signature of Parent or Guardian if entrant is age 17):

Mail to:
Dani Ranger Memorial Fund 26 Marble Lane Dixfield, Maine 04224

Date: