Saturday, February 28, 2015 - Cantrell Center for Physical Therapy

Saturday, February 28, 2015
Race Day Registration @ 7:30am
Run to Lose 5K @ 8:30am
1 Mile Fun Run @ 9:15am
Cash Prizes (we allow double dipping)
USATF-Certified Course
Peach Tree Road Race Qualifier
**Male & Female trophies/prizes for each level**
1st Place
$500.00
2nd Place
$250.00
3rd Place
$100.00
Overall Masters
$250.00
1st Place Lower Extremity Amputee*
$75.00
2nd Place Lower Extremity Amputee*
$50.00
*Donated by Boland Prosthetics
● Trophies for top three finishers in each age group
● Ribbons for the 1 mile fun run
CATEGORY (check one box below)
5K
Our mission is to obliterate obesity! Check out the resources available to you at
www.cantrellcenter.com
RSVP to the event: “7th Annual Cantrell
Center Run to Lose 5K & Fun Run”
on Facebook!
*Additional Cost for Shirt Sizes 2X/3X*
____ ___
Pre-registration for 5K (before 02/28/15):
Macon Tracks Running Club Member:
Cantrell Wellness Center Member:
Student ____________________________:
_____
FUN RUN
$25
$24
$20
$20
1 Mile Fun Run: $15
(name of school printed)
RACE DAY REGISTRATION FOR 5K $30 for all participants
(Please note price increase when registering on 02/28/15)
PARTICIPANT INFORMATION (PLEASE PRINT)
FIRST Name:_____________________________________ LAST Name:____________________________________
Address: _________________________________________ City: ___________________________ State:_____ Zip: ________
Phone Number: _______________________ Email: ______________________________________ Birthdate: _______________
MM/DD/YY
Gender: _________ Is this your first time entering a run/walk event? __________ Are you a lower extremity amputee? _________
:
Predicted Time:
IMPORTANT! If no time listed, you will be considered a walker.
Are you part of a Team? _________
min
sec
If so, enter Team Captain’s Name: ____________________________
ALL participants will receive a 5K T-shirt.
T-shirt size is not guaranteed for registrations received after 02/05/2015
T-shirt size
Mail In or Drop Off Registration Form to:
Cantrell Center- 5K
405 Osigian Blvd.
Warner Robins, GA 31088
(check one box below)
Make checks payable to: Cantrell Center
Small Medium
Large
XLarge 2XL(+$3) 3XL(+$3)
Pmt Type:
Cash
CK# _______
CC_______
___________ + _________________ = Total Paid: ________
Registration Fee
(+ $3 if shirt size 2X or 3X)
In consideration of the acceptance of this entry form, I hereby waive any and all claims for myself and my heirs against officials, hosts, and/or sponsors of the Cantrell 5K
for injury or illness, which may directly or indirectly result from my participation. I further attest that I am in proper physical condition to participate in this event.
I further understand that I may appear in photos that may be used for educational or publication purposes. I understand that payment for this event is non-refundable
and the event will go on rain or shine.
Signature:_______________________________________________
(Signature of participant or parent/guardian if participant if participant is under 18)
Date:_____________