September 5, 2015
Treynor Community Center
Treynor, Iowa
In Memory
8:30 am Start Time
Wm Rich Livengood
Celebrate life and experience how one life touches so many others. In a time
of sadness and confusion we must find a way to move forward , start to live
again, and let healing begin. . .
Raising funds for suicide awareness.
NAME______________________________________
ENTRY FEE—$25.00/person
ADDRESS___________________________________
MAIL CHECK PAYABLE TO:
CITY/STATE/ZIP______________________________
AGE RACE DAY______
Complete Timing
GENDER______
Liven’ Good Memorial
EMAIL_____________________________________
916 Park Street
PHONE____________________________________
SHIRT SIZE (circle one) YM
EVENT (circle one)
YL AS
Open Class 5K
AM AL
AXL
Syracuse, Ne 68446
AXXL
Firefigher/EMS Class 5K
1 Mile Walk
Virtual Runner*
*A virtual runner is someone who is unable to attend in person, but would like to contribute and receive the event shirt/swag.
**Entry fees are nonrefundable. Must register before August 17, 2015 to be guaranteed event shirt/swag.
Yes I would like to receive emails about upcoming events
Waiver: I know that running a road race is a potentially hazardous activity. I should not enter unless I am medically able and properly
trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with
running in this event included but not limited to: falls, contact with other participants, the effects of the weather, including high heat or
humidity and/or rain/snow, traffic and the condition of the roads, all such risk being known and appreciated by me, Having read this waiver and knowing these facts and in consideration of your accepting my entry. I for myself and anyone entitled to act on my behalf, waive
and release Complete Timing and its associates, the City of Treynor IA, Pottawattamie County, The Treynor Community FoundationCommunity Outreach, Treynor Community Center, Heather Livengood and family, and all sponsors, their representatives and successors
from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or
carelessness on the part of the persons named in the waiver. Further, I hereby grant full permission to any and all of the foregoing to use
photographs, videotapes, motion pictures, and recordings of me, or any other record of this event, for any legitimate purpose.
Participant Signature_____________________________________
Date______________________
Signarture of parent/guardian if under 18__________________________________________________