(copy-paste-fill out- return by mail)
Wishek 5K Walk/Run Entry Form
The 7th Annual Wishek 5K kicks off at 8:00am on Saturday, June 18th, 2016. Registration will begin at 7:30am at the Greg & Kay Weber residence, east of Wishek.
Entrance fee: $25 Participant wanting short sleeve t-shirt; $30 Participant wanting long sleeve shirt. All proceeds will go toward the new Mini Tumblers Gymnastics Program to help defray the cost of equipment.
City, State, & Zip: _________________________
Birth date (MM/DD/YYYY): _____/_____/_____
Age on Race Day: ______
Walk ____ Run ____
Shirt Size: S M L XL Other ________
Shirt Preference: Short Sleeve___ Long Sleeve___
(Shirts guaranteed to those entered by June 1st, 2016)
**Encouraged to participate by: __________________________________________
(An award will be given to the person or business that recruits the largest group!)
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.”
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)