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THE 5th ANNUAL GREY RIBBON CRUSADE 5K & 1 MILE, & KIDS RACE
Website: www.GreyRibbonDubuque.org
Come join us for a run in memory of Jim Boughton and all who are in the fight against brain cancer.
Walkers are welcome to participate but must stay on the sidewalks. Same fees apply.
DATE:
Memorial Day Monday, May 25th, 2015
TIME:
8:00 a.m. kids fun run, 8:20 a.m. 5k race, 1 mile race to follow
PLACE:
Race will begin in the Senior High parking lot @ 1800 Clarke Drive, Dubuque, IA. Participants will run
down Clarke Drive into Madison Park, turnaround, then continue back onto Clarke Drive to Senior for
the finish into the new Dalzell Track Stadium. The one mile races will be on the track (4 laps).
COST:
$20.00 prior to May 21th
No extra fee will be charged for entering both the 5K & 1mile race
LATE ENTRIES WILL GET A SHIRT ONLY IF AVAILABLE
REGISTRATION IS AVAILABLE THE MORNING OF THE RACE FROM 6:30 to 7:30 am. COST IS $25
PACKET PICK UP: Race morning from 6:30 a.m. till 7:45 a.m. in the Dalzell Track Stadium
ENTRY INCLUDES: Post-race refreshments, official race shirt, and rest room facilities will be on site.
PRIZES: Medals awarded to overall male and female winners as well as the top three places of each age group in 5K race
Medals for 1st , 2nd, and 3rd overall place for Men & Women will be awarded in the 1 mile race
1st, 2nd , and 3rd place girl & boy for Kids 1 mile race.
Unclaimed awards
ENTRY FORM
will not be forwarded.
Registration (before May 21): $________
Name:________________________________________________
Race Day Fee $25
$________
XXL T-Shirt:
$________
Additional Donation:
$________
========
$________
Address: ______________________________________________
City: ________________________ State: ________ Zip _______
Ph. # (
) ___________________________
E-Mail_______________________________________________
Date of Birth ____ / ____ / ____
MM
DD
Please make checks payable to:
Ram Booster Club Grey Ribbon
YY
Circle one category:
Sex
Male
Age
14 &Under
Female
15-19
RACE: ___ 5k run/walk
20-29
Total:
30-39
40-49
___1 mile race on track
50-59
60+
___Kids run
If wearing spikes, ¼ inch only will be allowed on the track
T- shirt (adult sizes)
please circle: S
M
L
XL
___ No T-shirt necessary
XXL (add $2 to fee)
Mail entry to: Grey Ribbon Crusade
c/o Lisa Wittman
16674 Wittman Hamm Ct.
Dubuque, IA 52001
Office use
Amount Rcvd: $_________ Date:______
WAIVER:
In consideration of the foregoing, I, for myself, my heirs, my executors, administrators, and assignees, do hereby waive
and release any and all rights and claims for damages I have against the Grey Ribbon Crusade, its officers, directors,
agents, and volunteers, Senior High School, City of Dubuque, and any and all participating supporters for all claims of
damages, demands, actions whatsoever in any manner arising or growing out of my participation in said race known as the
Grey Ribbon Crusade 5k. I attest and verify that I am physically fit and have sufficiently trained for the completion of this
event and my physical condition has been verified by a licensed medical doctor.
Signature________________________________________________
Date_______________
Parent Signature_______________________________________________(Required if under 18 years of age)