GOING, GOING...GOBBLE 5K

GOING, GOING...GOBBLE 5K SUNDAY, NOVEMBER 19, 2017 BEGINS & ENDS:

TIME :

Pollard School

9:00am

120 Main St Plaistow, NH 03865

SUNDAY, NOVEMBER 19, 2017 ____________________________________________________________________________________________ Name ____________________________________________________________________________________________ Email Cell Phone for text of results ____________________________________________________________________________________________ Address ____________________________________________________________________________________________ City State Zip Code ____________________________________________________________________________________________ Phone Age Date of Birth Gender In consideration of my acceptance of this entry, I hereby for myself, my heirs and assigns, waive any and all claims I may have against the YMCA of the North Shore volunteers, all sponsors, and the representatives for any and all injuries by me in the said event. I attest that I am physically fit and trained for the event and competition.

____________________________________________________________________________________________ Signature ____________________________________________________________________________________________ Parental Signature (If Under 18)

Pre-Registration Fees Adult 5K: $25

13& Under 5K: $15

Please Check One: 5K Race T-Shirt Size Ladies  Unisex Small Medium XX-Large(Unisex Only) Youth Medium Youth Large

I am paying with: QUESTIONS: For more information please contact: Timothy Short [email protected]

 Cash

Large

X-Large

Check

Make Checks Payable: PLAISTOW COMMUNITY YMCA Check #______________

Would you like to donate an additional amount to the Annual Campaign? $_____________

GOING, GOING...GOBBLE 5K COURSE MAP

PRESENTING SPONSOR:

ADDITIONAL RACE SPONSORS: