| Entry Form (1 per Contestant) |
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Event Details |
| Name __________________________________________________ |
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5K Run/Walk - 10K Run |
| Address ________________________________________________ |
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Saturday - July
3, 2010 |
| City ___________________________ State ______ Zip _________ |
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| Phone _________________________________ |
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Time: 10K begins at 8:00 AM -- 5K
begins at 8:00 AM |
| DOB _______________________
M or F |
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Course: Race begins and
ends at the Rodeo Grounds. The traffic-controlled |
| Circle Division: 19 & under
20-29 30-39 40-49
50-59 60+ |
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race course will end along the
parade course. |
| Circle Event: 5K Walk/Run 10K Run |
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| Circle T-shirt size: S
M L XL |
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Divisions: 19 & under /
20-29 / 30-39 / 40-49 / 50-59 / 60+ |
| (Pre-registrations made after June 15th are not
guaranteed a t-shirt) |
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Pre-Registration: Submit
application and entry fee of $20 |
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The Stampede |
| Waiver: Upon the acceptance of my
entry in the Stampede Run/Walk for Manawa |
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c/o Mid-Western Rodeo |
| Rodeo on July 3, 2010, I release
The Little Wolf River Trail Committee, Manawa |
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Box 952 |
| Lions Club, and any other
entities or individuals connected with this event |
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Manawa, WI 54949 |
| (including volunteers assisting
with the event) from any liability or claims |
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| for injury or illness sustained
during my participation in this event. I know that |
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Registration: 7 AM on race
day - $25 entry fee |
| running a race is a potentially
hazardous activity. I should not enter unless I am |
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| medically able and properly
trained. Further, I hereby grant full permission |
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Post-Race Activities:
Music, refreshments to follow, |
| without compensation to use any
photographs, recordings, or video tapes of this |
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downtown parade, rodeo (discounted rodeo voucher) |
| event for legitimate purpose. |
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| Signature
___________________________________ Date _________________ |
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Further questions call Ellen
Celske (920) 419-4465 |
| Legal Guardian (if under 18)
________________________________________ |
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Sponsored by Manawa Lions Club
and |
| Please enclose checks payable to
Little Wolf Trail Committee |
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Little Wolf Trail Committee |
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| FUNDS RAISED WILL BENEFIT THE LITTLE WOLF RIVER RECREATIONAL TRAIL |