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Marengo Memorial Hospital

Brickyard Hill Vineyard 5K Run/Walk Entry Form

Sunday, June 11, 2017

Starting Time: 9:00AM
Starting Place: Fireside Winery’s Brickyard Hill Vineyard
2088 160th Street Marengo, IA

The 5K run/walk will take participants on a marked route through Fireside Winery’s Brickyard Hill Vineyard. The Brickyard Hill Vineyard is located at 2088 160th Street Marengo, IA. (Note: The vineyard is southwest of the town of Marengo and not at Fireside Winery.) At 11:00 am, following the run/walk, an awards presentation will be held at Fireside Winery. Stay and relax at Fireside Winery with food, wine and live music. Ace Jones will be performing from 11-1:30 and Billy Heller from 2-5. Proceeds from this event benefit the Marengo Memorial Hospital Foundation and are used to provide for future healthcare needs. Join us for a morning run, jog or walk through the beautiful vineyard and spend your afternoon relaxing at Fireside. No pets, strollers or children under 12 allowed.

Advance Registration: $20.00 (Registrations received by May 25, 2017 will receive a t- shirt)

Race Day Registration: $25.00
(Race Day registration begins at 8:00AM at the Brickyard Hill Vineyard Marengo, IA)

Medals will be given to the first three places in each category.

Awards: Additional awards will go to the best overall times for the following:

* Best Overall Female Time
* Best Overall Male Time

Sponsored by Fireside Winery and Marengo Memorial Hospital Foundation

For more information contact the Marengo Memorial Hospital Foundation at 1-319-642-8054.
Please fill in the fields below.

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Entry Form Information
* Name:
* Phone:
* Address:
* City:
* State:
* Zip Code:
* Email Address:
* Race Category:
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* Gender:
* Shirt Size Adult:
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* Advance Registration:
Registrations received by May 26, 2017 will receive a t- shirt.
Note: 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 Brickyard Hill Vineyard 5K 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 Name:
* Date:
  Parent or Guardian Name if under 18 years of age:
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