Sunday, May 13, 2012

Register today for Wishek's 5K Walk/Run

For an updated entry form for 2013 click here

Wishek 5K Walk/Run Entry Form
The 3rd Annual Wishek 5K kicks off at 8:00am on Saturday, June 16th, 2012.  Registration will begin at 7:30am at the Greg & Kay Weber residence, east of Wishek, North Dakota. 
Entrance fee is $20. All proceeds will benefit Prairieview Hospice.

Name: ___________________________________
Address: _________________________________
City, State, & Zip: _________________________
Day Phone: _______________________________
Birth date (MM/DD/YYYY): _____/_____/_____
Age on Race Day: ______

Walk ____     Run ____

Shirt Size:  S   M   L   XL      Other ________
(T-shirts guaranteed to those entered by June 1st, 2012)

Release Statement
In consideration of my entry into the Wishek 5K Walk/Run, I, the below signed, intending to be
legally bound, do hereby for myself, executors and administrators, waive, release, and forever discharge
any and all rights and claims for loss, damages, or injury to my persons or property arising out of my
performance or failure of performance, from the Wishek 5K Walk/Run.
“By signing below you have read and agreed to the release statement.”

___________________________    _________
Signature                                             Date

Parent/Guardian Signature (If under 18 years of age)

Please return entry form & fee to Sonia Salwei, 903 1st Ave N, Wishek ND 58495.
(Please make check payable to Wishek 5K)

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