Register today for Wishek's 5K Walk/Run

For an updated entry form for 2013 click here

Wishek 5K Walk/Run Entry Form

The 3^rd Annual Wishek 5K kicks off at 8:00am on Saturday, June 16^th, 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 1^st, 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 1^st Ave N, Wishek ND 58495.

(Please make check payable to Wishek 5K)