Information of the 5k run/walk on June 22rd
Nora Springs Lion's Club is hosting the 1st annual 5k Buffalo run/walk. It will start/end
next to Boulder Park at 8:30am. For those not pre-registered that will start at 7:45am.
Medal's will be awarded after race with multiple events following. Please print, fill out,
and mail to below address! Happy racing!!
next to Boulder Park at 8:30am. For those not pre-registered that will start at 7:45am.
Medal's will be awarded after race with multiple events following. Please print, fill out,
and mail to below address! Happy racing!!
Buffalo 5k Race Registration
presented by Nora Spring Lions Club
Name: _________________________________________________________
Street:__________________________________________________________
City:___________________________________________________________
State:________________________ Zip Code:_________________________
E-mail:_________________________________________________________
Age on 6/22/13:__________________________ Gender:_________________
Entry Fee (proceeds will go to Lions Club and building and maintainance fee's)
5k run/walk $15 (includes t-shirt) before 5/29/13 otherwise $20 after 5/30/13
Please make checks payable to: Nora Springs Lions Club
Mail to: 5k Race, PO Box 68, Nora Springs, Ia 50458
In consideration of your acceptance of this entry, I hereby, for myself, my heirs, executor,
administrators, waive any rights and claims and damages I may have against the Nora
Springs Lion's Club and individuals or groups associated with this event, their agents,
assigns representatives, successors for any and all injuries suffered by me in said event.
I attest and verify that I have full knowledge of the risks involved and am physically fit and
sufficiently trained to take part in this event. I also give permission for the free use of my
likeness or picture for publicity or solicitation.
Signature*________________________________________ Date:____________________
* parent or gaurdian if under 18
Circle Adult T-shirt size: S M L XL 2XL
Additional shirts: $12 S M L XL 2XL youth: XS S M L
Street:__________________________________________________________
City:___________________________________________________________
State:________________________ Zip Code:_________________________
E-mail:_________________________________________________________
Age on 6/22/13:__________________________ Gender:_________________
Entry Fee (proceeds will go to Lions Club and building and maintainance fee's)
5k run/walk $15 (includes t-shirt) before 5/29/13 otherwise $20 after 5/30/13
Please make checks payable to: Nora Springs Lions Club
Mail to: 5k Race, PO Box 68, Nora Springs, Ia 50458
In consideration of your acceptance of this entry, I hereby, for myself, my heirs, executor,
administrators, waive any rights and claims and damages I may have against the Nora
Springs Lion's Club and individuals or groups associated with this event, their agents,
assigns representatives, successors for any and all injuries suffered by me in said event.
I attest and verify that I have full knowledge of the risks involved and am physically fit and
sufficiently trained to take part in this event. I also give permission for the free use of my
likeness or picture for publicity or solicitation.
Signature*________________________________________ Date:____________________
* parent or gaurdian if under 18
Circle Adult T-shirt size: S M L XL 2XL
Additional shirts: $12 S M L XL 2XL youth: XS S M L