4th Annual Make A Wish 5k Run/Walk Saturday, May 16, 2015 ~ 8:00 a.m. ~ Dixon, IL Registration Information Register By Mail or Register On-line at https://register.chronotrack.com/r/13248 Race Day Registration and Packet Pick-Up Saturday, May 16th – 6:45-7:45 a.m. at race site 5k Run/Walk Fees $20 Early Registration prior to 5/1/2015 $25 Late Registration after 5/1/2015 RRRR Club Members ONLY: $18 Early Registration prior to 5/1/2015 $25 Late Registration after 5/1/2015 Course and Race Information The race begins and ends at Washington Elementary School, 703 East Morgan Street, Dixon, IL. Fast, flat course on Lowell Park Trail with water station. NEW for 2015! Course is chip timed. Awards ceremony immediately following race. Race will be held rain or shine. In case of inclement weather, thank you for your donation. Race is featured as a 2015 Rock River Road Runner’s Circuit Race. Discount for early registration applies to RRRR Club members only. Technical race shirts are guaranteed with early registration. Awards Awards will be presented to the overall male and female finishers. NEW for 2015- awards will also be presented to the overall Masters male and female finishers! Medals will be presented to the top three male and female finishers in the following age categories: 10 & Under, 11-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70 & Over Make Checks Payable to Trevor Belzer All proceeds benefit Make-A-Wish Foundation! Race Website: Contact Information www.makeawish5k.webs.com Find Us on Facebook: Dixon Make a Wish 5k Trevor Belzer, Race Director Phone: 563-343-2897; Email: [email protected] Lisa Knebel-Cullen, Make-A-Wish Representative Email: [email protected] THANK YOU FOR YOUR SUPPORT OF MAKE A WISH! (mail with payment to: Trevor Belzer, 378 Kilgore Road, Dixon, Illinois 61021) First/Last Name: ________________________________________________________________ Gender: M F Phone Number: ________________________________ Email:_____________________________________________ Address: ________________________________________________________________________________________ (Street) (City) (State) Age on 5/16/2015: ___________ Birth Date: ______/________/________ mm Register for: day year _____ 5K Run/Walk - $20 prior to 5/1/2015; $25 after 5/1/2015 _____ RRRR Club Members Only - $18 prior to 5/1/2015; $25 after 5/1/2015 (Zip) Sport Performance Technical Shirt Size: Adult sizes: S M L XL *shirts are technical shirts featuring moisture management. Shirts are guaranteed with early registration. Shirts available on race day in limited quantities. Shirts run SMALL. Release and Wavier: In consideration of my entry, I, intending to be legally bound, for myself, my heirs, executors, administrators, and assignees, waive, release, and forever discharge any and all rights and claims which may hereafter accrue to me against Washington Elementary School, Dixon Public Schools, Make-A-Wish Foundation, the 5k Race Committee, City of Dixon, Dixon Police officials, Dixon Park District and all other sponsors, officials, and volunteers for any and all accidents and injuries incurred by me at or during this event. I further state that I have trained adequately and am in suitable condition to compete in this event. Signature: ___________________________________________________________________________________Date: ____________________ Parent Signature (for participants under 18):____________________________________________________________Date: ____________________
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