Individual Registration Form Name:_______________________________________________________ Age:____________ Gender: (Circle One) Male / Female Shirt Size: (Circle One) Women’s Men’s Youth S S S M M M L L L XL XL XXL XXL **Shirts are dry fit performance shirts □ Yes! I am participating with my dog! Dog’s Name:__________________ Address:______________________________________________________ City/State/Zip:_______________________________________________ Run For Their Lives! 5K Run/Walk Date: Saturday, May 30th, 2015 Location: Doepke Park, Rib Mountain, WI *Benefiting the Humane Society of Marathon County Time: Registration: 7:30 to 8:30 am 9:00 am Chip timed 5K start ***Participants accompanied by dogs will start behind competitive runners. Phone:________________________________________________________ E-mail:________________________________________________________ Please include my e-mail in future correspondence regarding the race and other fundraising events from the Humane Society of Marathon County: Yes / No I do hereby release and hold harmless the Humane Society of Marathon County 5K Run/Fun Walk, including all organizers, sponsors, volunteers, and property owners from any and all liability resulting from my participation in this event for any reason. I understand that I, or my dependent, is participating in said run at our own risk. I understand that my registration fee is nonrefundable if the event is cancelled due to inclement weather. Cost: $30 before May 15th, 2015 Signature:_____________________________________________________ **Teams of 4 or more $25.00 per person (use team reg. form) $35 after May 8th, 2015 ***Non-refundable if race cancelled due to inclement weather Guardian Signature (If under 18): ___________________________________________________________________ Registration alternatives: Active.com or printable registration brochure at www.hsmcrunfortheirlives.com Timing: Professional timing provided by Performance Timing Parking: available at South Mountain Elementary, 5400 Bittersweet Road, Wausau WI Awards: will be distributed by age division Please make checks payable to HSMC Mail to: Humane Society of Marathon County Attn: Mary Kirlin 7001 Packer Drive Wausau, WI 54401 Proudly Sponsored by: ausau, WI 5440 Run/Walk participants who register early will be provided a performance dry fit t-shirt as well as post race refreshments. *Please register before May 8th to guarantee shirt availability. Volunteers are welcome! If you would like to organize a volunteer force for this race/walk please contact HSMC’s Volunteer Coordinator for more information! Wisconsin State Statute requires all dogs 4 months and older to be rabies vaccinated, and 5 months and older to be licensed. If you are running with your furry friend, please have his tags securely fastened to his collar or harness. Central WI Animal Emergency Center * Briq’s Soft Serve * CoVantage Credit Union * BMO