Your browser does not support JavaScript!
This form cannot automatically check that you have submitted all of the required fields without JavaScript.
Please be sure to submit all required fields (marked with stars).

Marengo Memorial Hospital

Marengo Memorial Hospital Foundation 5K and 10K Run / Walk

Saturday August 19, 2017

Register and bring payment day of.

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 refreshments will follow the event.

Race Day Registration: $25.00 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
To Be Announced
For More Information Contact the Marengo Memorial Hospital Foundation at 1-319-642-8054
Marengo Memorial Hospital Foundation
5K Entry Form / 10K Entry Form (Please circle category)
(Advanced Registration of $20 due August 1, 2017)
Race Day Registration $25
* Race Day Registration: $25.00
* Billing Name
  Phone
* Billing Address
* City
* State
* Email Address
* Credit Card Type Visa
Master Card
* Credit Card Expiration Date
* CV3 Code
  Comments Or Messages Related To Your Payment
Race Category
  14 and Under Male
Female
  20-29 Years Male
Female
  40-49 Years Male
Female
  60 Years + Male
Female
  15-19 Years Male
Female
  30-39 Years Male
Female
  50-59 Years Male
Female
  Shirt Size-Adult Small
Medium
Large
X-Large
XX-Large
XXX-Large
 
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