Marengo Memorial Hospital Foundation

                        “Running/Walking for the Future”                     
5K Run / Walk
Saturday August 21, 2010

 

Starting Time:  7:30AM

Starting Place: Marengo Memorial Hospital

300 West May Street   Marengo, IA

 

The race will take participants on a marked route in Marengo. This event is sponsored by the Marengo Memorial Hospital Foundation, a nonprofit organization. Proceeds will benefit the Marengo Memorial Hospital Foundation and be used to provide for future healthcare needs.  Each participant will receive a gift bag of items. Awards and pancake breakfast following the race at the American Legion.  A free will offering will be taken to cover the cost of the breakfast.

Advance Registration:  $15.00   Registrations received by August 6, 2010 will receive a t- shirt      

Race Day Registration: $20.00   Race Day registration begins at 6:30AM at the Marengo Memorial Hospital ____________________________________________________________________________________________________________                               AWARDS
Medals will be given to the first three places in each category. Additional awards will go to the best overall times for the following:

• Male and Female 14 Years of Age and Under
• Male and Female 15+ Years of Age

_________________________________________________________________________________________________________________________

 

RACE SPONSORS

Stiefel Insurance-Victor    RehabVisions    Cornerstone Apothecary –Marengo & Van Horne  
Kloster Funeral Homes-Marengo & Brooklyn

  Don Hummer Trucking-Oxford    Dr. John Wollner, Dermatologist   
Lifetime Chiropractic-Williamsburg     Dr. Kim Lozier, Podiatrist

        

      For More Information Contact the Marengo Memorial Hospital Foundation at 1-866-930-8842_______

 

Marengo Memorial Hospital Foundation

5K Entry Form

(Advanced Registration of $15 due August 6, 2010)

Race Day Registration $20

 

Name_____________________________________________Phone______________________

 

Address______________________________________ City ______________State___________

 

Race Category

14 and Under      ____Male ____Female                              15-19 Years        ____Male ____Female

20-29 Years        ____Male ____Female                              30-39 Years        ____Male ____Female

40-49 Years       ____Male ____Female                              50-59 Years        ____Male ____Female

60 Years +          ___Male ____Female

    Shirt Size-Adult             _____Small   _____Medium    _____Large   ______X-Large    _____ XX-Large    _____XXX-Large

 

Only Advanced Registrations Are Guaranteed Race T-shirts       Registration Fee is Non-Refundable

 

I recognize the risks associated in any athletic event and hereby waive, release and hold harmless all sponsors, contributors, supporters, volunteers and officials associated with the race and event, from any and all liability, claims and rights for damages from injuries growing out of,  related to, or arising from participation in the Marengo Memorial Hospital Foundation Run/Walk.  I further certify that I have full knowledge of the risks involved in this event and that I am physically fit to participate.  If however, I do require medical attention as a result of my participation in the above mentioned activities, I authorize the medical personnel associated with said event to provide such medical care as is deemed appropriate by such medical personnel.

 

Participants Signature______________________________________________Date_______________

 

Parent or Guardian Signature if under 18 years of age________________________________________

 

Send Entry Form and Check Payable to Marengo Memorial Hospital Foundation

 300 West May Street, Marengo, IA 52301.