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Please return with your payment
by Monday, April 27, 2015
23rd Annual Fayette County Civitans
Old Courthouse 5K Road Race
Corporate Sponsorship
Contact Name:
Business Name:
Phone:
Address:
FAX:
Email: _______________________________________
Website URL:
Here is our commitment for support of the medically fragile of Fayette County through the proceeds of the 23rd Annual Old Courthouse 5K Road Race to be held
Saturday, June 13, 2015, at 8:00 am.
√
CATEGORY OF SUPPORT
REMARKS
(items, amount, etc.)
$ 5,000
Status of Anchor Sponsor, Large, full-color logo on t-shirt
(Send color logo)
$ 2,500
Large full-color t-shirt logo (we’ll use in promotions and website)
(Send color logo)
$1,500
10” Color t-shirt logo (we’ll use in promotions and website)
(Send logo)
$ 1,000
8" t-shirt logo
(we’ll use in promotions and website)
(Send logo)
$ 500
4" t-shirt logo
(we’ll use in promotions and website)
(Send logo)
$ 250
2" t-shirt logo
(we’ll use in promotions and website)
(Send logo)
Door Prizes
Merchandise, gift certificates, etc., to be given away at award ceremony
Other
(i.e. cash donations, etc., specify what)
List:
Please Mail to: Bob Chatham, Corporate Coordinator, Fayette Civitan 5k, 280 Otter Circle, Fayetteville, GA 30215-5273
For additional information, please call 770-461-7913 or email: [email protected]
* * DRAFT * *
Runner Entry Form
Fayette County Civitan Club’s
23RD ANNUAL OLD COURTHOUSE 5k
Saturday, June 13, 2015 - 8:00 am
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Proceeds To:
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Starting Line:
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Prizes
& Awards:
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The Joseph Sams School, ExceptionalOPS, Fayette County Special Olympics,
and Southwest Christian Care (Hospice, Hope House, Senior Care, Spiritual Care).
Fayette Senior Services, 4 Center Drive, Fayetteville, GA 30214
(Parking provided at the Fayette County Justice Center parking lot.)
Original artwork, t-shirt
Door Prizes
First and Second Place Male and Female runners in each age group receive
dated, etched-glass Old Courthouse Medallions
Overall First Place Male & Female runners receive large, dated etchedglass Medallion on a wooden base
www.active.com/running/fayetteville-ga/23nd-annual-old-courthouse-5k-2015
(Register on line by 06/11/2015)
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Information:
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2014 (Last Year’s)
CORPORATE
SPONSORS:
9 & Under
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70 & Over
Announcing a plan for 2015… Bring a non-perishable zip-open food item
to help Fayette Samaritans AND Rushton Hope Mission feed the hungry!
ENTRY FORM
23rd ANNUAL OLD COURTHOUSE 5k ROAD RACE - Saturday, June 13, 2015, 8:00 am
Registration:  1. MAIL-IN - Postmark by June 8. Mail form to: Fayette County Civitan 5k, c/o CHATHAM, 280 Otter Cir., Fayetteville, GA 30215.
Make check or money order to Fayette County Civitan Club. Pre-registration $25.00. Register on-line by June 11, 2015, at
www.active.com/fayetteville-ga/running/races/23rd-annual-civitan-old-courthouse-5k-2015 (Visa, MC, Amex)
Name:
 2. Day of Race - 7:00-7:45 am Sat., June 13, 2015 Fayette Senior Services Center, 4 Center Drive, Fayetteville, GA 30214. (Parking Lot)
Race Day Registration $30.00 (Cash or Check). (PLEASE NOTE STARTING LINE LOCATION.)
Email:
Address: _______________________________________________________________________
City:
State:
T-shirt Size:
Telephone: (
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M
L
XL
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(Circle one)
Zip:
Event:
5k ____
Just TShirt ____
Date of
Birth ___/___/_____ Age ____
Male ___
Female ___
In consideration of acceptance of this entry, I waive any and all claims for myself and my heirs against officials and sponsors of the 2015 23rd Annual Old Courthouse 5K Road Race for injury
or illness that may result directly or indirectly from my participation. I further state that I am in proper physical condition to participate in this event.
Runner's Signature & Date
Signature of Parent if runner under 18