Pound the Pavement Walk/Run
Village of Pound Park
Parkview Ln. & Cty. Q (1 block West of Bus. 141/CP) ~ Pound, WI 54161
7:00 – 7:45 a.m. ……………….………Race day Registration
8:00 a.m. ………………………………….Race Starts
* Awards will be given out right after the last person finishes. *
Medals Awarded
10k Run: 1st, 2nd & 3rd place for both men & women.
5k Run: 1st, 2nd & 3rd place for both men & women.
5k Walkers: 1st, 2nd, & 3rd place for both men & women.
Proceeds this year will go to Coleman Area Library
located on Main St. in Coleman, WI.
To be a Sponsor: A $50.00 donation gets name on T-shirt only.
$150 or more gets name on ALL advertisements & T-shirt.
Deadline July29, 2011.
Check the sponsor Yes box and send application & payment.
www.cougarcountrybusiness.com
2011 Walk/Run Entry Form
(One form per person)
Name
First Last
Business Name
Address
City State Zip
Sex Age on August 20, 2011
Contact Number
E-mail
Pre-Registration $15 / Race Day Registration $20
Registrations must be postmarked by August 5, 2011.
Registrations after August 8, 2011 T-Shirt is not guaranteed.
No Refunds or Transfers Check Only one
Specify T-Shirt size:
Send registration &/or sponsorship with checks payable to:
Cougar Country Business Association
P.O. Box 38
Coleman, WI 54112
Waiver and Release Statement: In consideration of the foregoing, I, for myself, my heirs, executors, administrators, personal representatives, successors and assigns, waive and release any and all rights, claims, and causes of action I have or may have against Pound the Pavement Walk-Run and its affiliates, their agents, employees, officers, directors, successors and assigns, and any and all sponsors, their representatives and successors that may arise as a result of my participation in the Pound the Pavement Walk-Run events and any pre- and post-race activities. I attest and verify that I am physically fit and sufficiently trained for the completion of this event and my physical condition has been verified by a licensed medical doctor. Further, I hereby grant full permission to any and all of the foregoing to use any photographs, motion pictures, recording, or any other record of this event for any legitimate purpose, including commercial advertising.
Waiver must be signed to be processed
Signature: _____________________________________ Date: ________________
Parent’s Signature: ______________________________ Date: ________________
(If under age 18)
To be a Sponsor: A $50.00 donation gets name on T-shirt only.
$150 or more gets name on ALL advertisements & T-shirt.
Sponsorship Deadline July 29, 2011.
Enclosed is Sponsorship fee
Major Sponsor:
