Cross Country Challenge 5K Walk/Run to benefit the “Wounded Warrior Project” DATE: May 2, 2015 TIME: 8:00 a.m. Registration begins at 7:00 a.m. LOCATION: Clyde Austin 4H Camp 214 4-H Lane Greeneville, TN (located next to Link Hills Golf Course/Country Club) ENTRY FEES: $20.00 Pre-Registration $25.00 After April 17, 2015 Shirts only guaranteed to pre-registered runners! Checks made payable to Laughlin Memorial Hospital. NO REFUNDS. ****100% of all proceeds go to the Wounded Warrior Project**** AGE CATEGORIES: Overall Winner Male & Female Winner; and 2 deep for each age group: 12 & under, 13-16, 17-25; 26-35; 36-45; 46-55; 5665; 66 & up If you would like to purchase a t-shirt ONLY (not participate in the run), please complete the form below and check the appropriate box. Shirts will be available the day of the run. Please fill out registration form & return to: Laughlin Memorial Hospital Tracy Green 1420 Tusculum Blvd. Greeneville, TN 37745 Ph#423-787-5097 COURSE: The challenge goes through the grounds of the 4H campus. It is a beautiful run around the lake, around the perimeter of the campus and through farmland. This is strictly a cross country event. This is not a certified course. PRE-REGISTRATION FORMS DUE BY APRIL 17, 2015 T-shirts guaranteed for pre-registered participants only! Last Name_______________ First Name_______________________ M.I.____ Sex_____ Age (on Race day): _______ T-Shirt Size (circle one): XS / S / M / L / XL / XXL / XXXL Please indicate if you ONLY want a t-shirt and are NOT entering the run/walk : t-shirt only______________ Address__________________________________________________________City_______________State_____Zip__________ Email Address _______________________________________ Home Phone____________________________ Work Phone__________________ Cell Phone______________________ Emergency Contact_________________________ Relationship________________ Phone Number_________________________ WAIVER: I certify that I am in good physical condition and understand the risk involved in my participation in this run. I hereby release and hold harmless the Clyde Austin 4H camp, Laughlin Memorial Hospital, and any others associated with this event; whether directly or indirectly for all liability as to any right of action that may occur to either the undersigned or his or her personal representative for any injury, loss of life, or damage to property. To assure the safety of all participants, unregistered runners, strollers, unauthorized vehicles, bicycles, skateboards, rollerblades, roller skates, and dogs are strictly prohibited from the course during the event. Signature of Competitor ______________________________________ Date____________________ Signature of Parent (if under 18) ________________________________Date____________________