REGISTRATION FORM
www.manheimdowntown.org
When: Saturday, May 30, 2015
5K RACE starts at 9:00pm
Check-in: Starting at 6:00pm
Where: Market Square in Downtown Manheim
Parking: On street parking in Manheim Borough and authorized downtown business parking areas
will be posted on the website prior to race.
AFTER 4.3.15
Course: Starts and Finishes on Main Street in downtown Manheim.
Rock-N-Glow 5K Race Shirts are Male/Female/Youth Cuts. Gildan 100% polyester jersey knit,
heat transfer label, Aqua FX ® for wicking properties, Freshcare ® for anti-microbial properties,
double-needle hemmed sleeves and bottom hem rib knit collar (no topstitch). Registrations
received after 4.2.15 does not include a free race shirt. Still want one? Please add $12/shirt
and mark boxes below. Limited registrations after May 15th.
Additional Shirts $12 each
GENDER:
YOUTH:
S
M
L
XL
ADULT:
MALE
S
M
FEMALE
L
XL XXL
Race Packet Pick Up: Thursday, May 28th and Friday, May 29th 4:00 - 7:00pm
at the Manheim Farm Show Complex located at 400 Adele Avenue, Manheim
Saturday, May 30th starting at 6:00 - 8:00pm on Market Square, Manheim
Awards: Awards will be given to overall race winner and male and female winners in each division.
The event will also feature music, vendors and door prizes!
FIRST NAME:
LAST NAME:
ADDRESS:
CITY:
STATE:
ZIP:
EMAIL ADDRESS:
PHONE NUMBER:
GENDER: M
D.O.B.
F
AGE ON RACE DAY:
EMERGENCY CONTACT:
EMERGENCY PHONE:
WAIVER: In consideration of the acceptance of this entry, I hereby waive and release any and all rights and claims for damages or injuries I may have against any and all race officials,
local municipalities, and the Manheim Downtown Development Group for any and all damages or losses that may be suffered by me before, during, and after this event such release
binding my heirs, creditors and assigns. I hereby grant permission to the aforementioned to use my name and/or photographs or videotape of this event without limitation or
obligation. I certify that I am physically fit for this event and understand the risks involved by participating in this event.
SIGNATURE:
(Parent or Guardian for Consent if Entrant is Under 18)
DATE:
Please enclose one registration form per racer. Checks made payable to the Manheim Downtown Development Group
Mail entry forms to the Manheim Downtown Development Group, 17 North Main Street, Manheim PA 17545 prior to May 15th
Questions: Please call the MDDG office at (717) 665-1762 www.manheimdowntown.org
4.2.15