Sponsorship Levels
gold
$250-$499
Includes: name on t-shirts, event banner
and all event advertisements
2 free race entries / t-shirts
SHAMROCK 5K
*added cycling event*
20, 40 & 60 mile routes
22nd Annual
SILVER
$100-$249
Includes: name on t-shirts and event
advertisements
1 free race entry / t-shirt
bronze
Door prize donation
Recognition at event awards
The Free Clinic of Danville relies on the generosity of
local business, foundations and citizens to support our
mission. We serve low income, uninsured residents
who are suffering from chronic diseases such as asthma,
diabetes and heart disease. Even with full implementation of the Affordable Care Act, the Congressional
Budget Office estimates there will still be 31 million
uninsured Americans through year 2023. We still need
your help in serving our community!
5K Run/Walk &
new BIKING EVENT
March 21, 2015
AT THE
Community Market
Free Clinic of Danville
3 free race entries / t-shirts
133 South Ridge Street
$500 & up
Includes: name on t-shirts, event banner
and all event advertisements
FREE CLINIC OF
DANVILLE
Danville, VA 24541
PlAtinum
REGISTRATION FORM
DANVILLE FREE CLINIC * SHAMROCK 5K
Race Start Time: 9:00 am for Cyclists
9:10 am for Run/Walk
SHAMROCK 5K RUN/WALK
& CYCLING EVENT (20-40-60)
SATURDAY MARCH 21, 2015
(Photocopies of form are permitted)
Name__________________________________
Address_________________________________
Riverwalk Trail: Start line near trestle
bridge.
Friday March 20 from 4-6pm at
“The Brick” at 410 Main Street, Danville
Parking:
State___________ Zip_____________________
Phone__________________________________
Trophies & Awards: (no duplication of
Email___________________________________
Circle: 5K Run — 5K Walk — Cycling 20-40-60
Shirt size: (First 150 entries) S
M
L
XL
*Walkers and Runners ONLY please complete:
*Age on race day __________ *Sex: M
F
Team Name_____________________________
**NOTE: ALL TEAMS MUST PRE-REGISTER
*(minimum 3 runners for teams)*
*Additional entry forms can be downloaded at:
danvillerunner.org
Mail entry form & check payable to :
Free Clinic of Danville
133 S. Ridge Street
Danville, VA 24541
OR register online at Eventbrite.com
WAIVER (all participates please sign)
In consideration of my entry, I (or my designee) do
hereby release & discharge the Free Clinic of Danville, their sponsors, volunteers and officials of all
claims and damages from my participation in this
fundraising event on March 21, 2015. I verify that I
have full knowledge of the risks involved and I am
physically fit and trained to participate in the event.
____________________________________________
Signature of runner or parent if under 18yrs
Date
finish in front of Community Market
Registration & Packet Pickup:
Saturday March 21 from 7:45-8:30 a.m.
at the Community Market.
No registration after 8:30am
City____________________________________
Course: *All participants will start and
Off Craghead Street at the
Community Market parking lot at the
Crossing on the Dan. Location is 1/2 mile
from Main street.
Restrooms:
At the Community Market
and the course at 1/2 & 3/4 mile markers.
overall age and group awards)
Awards Ceremony:
Runners:
Community Market following the race
Trophy to top 3 males/females
Trophy to top M/F masters (40 & over)
Trophy to top 3 M/F in each age group:
14& under
40-44
15-19
45-49
20-24
50-54
25-29
55-59
30-34
60-64
35-39
65-69
70&over
Walkers: Trophy to overall top
Male/Female walker
Trophies to top M/F walkers in age group:
19&under
40-49
20-29
50-59
30-39
60 & over
Running Teams:
Trophy to overall team with top 3 overall
finishers
Entry Fees: **No Refunds**
Pre-Race: $20 (thru Friday, March 13)
Race Day: $25
Door Prizes, Plus:
Door prizes will be
drawn during the awards ceremony. You
must be present to win.
For information, contact:
L.C. Moore: 434-793-3409
Free Clinic: 434-799-1223
The Free Clinic of Danville extends
our appreciation to all the
volunteers, sponsors and runners
who make our event a success!