Registration Form - Ryan’s Reindeer 5K Run/Walk
Saturday December 21, 2013
Name ________________________________________ Race Location: Medical Arts Bldg
Address_______________________________________ Downtown Fayetteville 101 Robeson St.
City ___________________________________State_____ Zip_______ Packet pickup and registration:12/20/2013
Contact Phone # ____________________________________________ 5 - 8 PM Breezewood Healthcare
E-Mail ________________________________________ 200 Forsythe Street Fayetteville, NC 28303
Age on Race Day _____________ Date of Birth ____________________ Race day packet pick up and registration
Male ________ Female _________ Saturday 12/21/13 7am at race site
Adult T-Shirt size (please circle): S, M, L, XL, 2XL($3 extra) Race Start: 8:30am
Youth T-Shirt size (please circle): YS, YM, YL .
To guarantee a T-shirt and reindeer ears registration must be received by November 30, 2013.
Entry Fee $25.00 Individual Runner/Walker, After December 7: $30.00
Under 13 Runner/Walker $15.00, After December 7: $20.00
Family Entry $75.00, After December 7: $90.00 (includes 4 T-shirts) 2 additional family members may register for $20.
Family registrants will not be eligible for individual prizes but will be eligible for the family prize. Times of
all family members will be added together to get the family time. A family consists of a minimum of 3 and a
maximum of 6 runners who are of the same family. Please complete a separate registration form for each
participating family member.
Individual Runner/walker $_________
Under 13 Runner/walker $_________ Cash or Checks Payable to: Family Entry $________ RPK Memorial Foundation
Extra Family Members (max 2) $20 each $________ PO Box 58034
Add $3 for each 2XL t-shirt requested $________ Fayetteville, NC 28305
Extra T-shirts (YS through Adult XL $12 each : 2XL $15 each)
S___ M___ L ___ XL___ 2XL_____YS ____ YM____ YL_____
Total for Extra T- shirts $_________
Optional Tax Deductible donation $ _________ Group Trophy to group with most members
Total Amount enclosed $ _______________ registered by December 20, 2013.
Group Name ___________________________
Please make sure to sign waiver and release form.
Waiver—Must be signed to participate
I understand that participating in this event is potentially hazardous, and that I should not enter and participate unless I am medically
able and properly trained. In consideration of the acceptance of this entry, I assume full and complete responsibility for any injury or
accident, which may occur while I am traveling to or from the event, during the event, or while I am on the premises of the event. I
also am aware of and assume all risks associated with participating in this event, including but not limited to falls, contact with other
participants, effect of weather, traffic and conditions of the road. I, for myself and my heirs and executors, hereby waive, release and
forever discharge the event organizers, sponsors, promoters, Ryan Kishbaugh Memorial Foundation, City of Fayetteville, Cumberland
County Hospital System, High Smith Rainey Medical Arts Building Association, EHM Finish Lines/Atlantic Coast Timing Services,
Breezewood Healthcare, and each of their agents, representatives, successors and assigns, and all other persons associated with this
event, for all liabilities, claims, actions, or damages that I may have against them arising out of or in any way connected with my
participation in this event. I understand that this waiver includes any claims, whether caused by negligence, the action or inaction of
any of the above parties, or otherwise. I understand that bicycles, skateboards, roller skates or blades are not allowed in the race, and I
will abide by these guidelines. I understand that the entry fee is non-refundable and non-transferable. I hereby grant full permission to
any and all of the above parties to use any photographs, videotapes, recordings or any other record of my participation in this event for
any legitimate purpose.
Signature Date Signature of Parent or Guardian (if under 18) Date