Mail In Registration
Second Annual Alumni Pride 5K and Popsicle Mile Fun Run/Walk
Dates: Saturday, November 2, 2013
Lecanto High School-sponsored by LHS Alumni Association
On the campus of Schools Complex
There will be race day registration.
Event Day Schedule:
7:45-8:45 = packet pickup and race day registration
9:00 a.m. = Alumni PRIDE 5K
10:15 a.m .= Popsicle Mile
Awards = 10:35 or earlier based on number of Popsicle Milers
COST= 20 dollars for 5K
10 dollars for Popsicle Mile
25 dollars for race day registration all events
AWARDS for 5K
Top two open winners
Top two masters
Top two each of the following age groups: 13 and under; 14-18; 19-29; 30-39; 40-49; 50 up
POPSICLE RUN
All finishers receive time and a popsicle
Come out and run a 5K on the campus of Lecanto Complex. .
Profits obtained from the registration charges will be donated by the alumni to Lecanto. The event organizers will be compensated.
Those who register by Noon, October 28 will receive a T shirt!! Bibs will be used.
Contact Mike Ossmann at 904 886 3344 or email at mikeossmann@nefcom.net Or Dierde Newton at Lecanto High (352742334) OR Ron Allan at Lecanto High or email allanr@citrus.k12.fl.us for a registration form if needed and more information on this or any other items.
REGISTRATION OPTIONS: 1. Online at active.com; there is a service fee through active.com. On active.com, you may use a credit card. 2. You can register by returning the form below. 3. You can drop off registration at the following locations: LHS (ATT:Ron Allan- Alumni 5K or Freddie Bullock- Alumni 5K) NO REFUNDS. Remember, there is no guarantee of t-shirts if register after noon, October 28.
Please Cut Off and Return to: Alumni 5K ATT: Freddie Bullock, Lecanto High School, 3810 West Educational Path, Lecanto, Florida 34461
Make Checks Payable to: LECANTO HIGH SCHOOL /age on date of race/check event(s) wish to do
Name: _______________________________________________________ Grade: _____ Age: _____ M/F____
I do ____ do not ______ give permission for my photo/child if under 18 to be placed on the event website.
Web site address = https://sites.google.com/site/athleticsscoringproviders/2013-road-races-or-5ks-etc/first-annual-alumni-pride-5k-and-popsicle-mile-fun-run-walk
Event (s): _____ 5K ____ Popsicle Mile Run
Address: (include zip) _________________________________________ Email Address: ________________
Parent/Guardian: (if under 18 day of event)___________________________Phone: H ______________ W____________
Emergency Contact: _________________________________________________ Phone: ________________________
Insurance Company: _______________________________________________ Policy #: _________________________
Allergies or medical conditions:________________________________________________________________________
Shirt Size: Youth Large Adult S Adult M Adult L Adult XL Adult XXL
I understand that running/walking is a physical sport and injuries may occur. I release the coaches, team members, sponsors, staff and administration of Lecanto High School, the Citrus County School Board, the members of the Alumni Association, the employees or sub-contractors from David D Bullock, LLC, timers and scorers,from any legal responsibilities for any possible injury or consequences that may occur. I also authorize the meet director/club sponsor of the event to act on my behalf if an injury occur and I cannot answer responsibly. I understand if my child under the age of 18 is participating, the same procedures apply to my child.
(Parent)Signature: _________________________________________________________________ Date: __________________________________
Date received: _____________________ Payment Type: Check #_____________________ Cash: ____________________ Received by: _________