2.62 Boston Stands As One - 5.2.2013 - 630 PM - Kamper Park - 107 7th Ave - Hattiesburg, MS.

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Registration
2.62 BOSTON STANDS AS ONE
Name: _____________________________________________ Age on Race Day:_______ DOB___/___/___
Address: ____________________________________________ Phone (home):__________ Cell:___________
City/State/Zip:_______________________________________ Sex (circle one) Male Female
Technical T-shirt size (circle one) S M L XL XXL
Email address:_______________________________________
Waiver for the 2.62 Boston Stands as One Run
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 this event, during the event, or while I am on the premises of the
event. I am also aware of the assumption of risk associated with participating in this event, including but not limited
to falls, contact with other participants, effect of weather, traffic, and condition of the road. I, for myself and heirs
and executors, hereby waive release and forever discharge the event organizers, sponsors, promoters, and each of
their agents, representatives, successors and assigns and all other persons associated with the event, for all my
liabilities, claims, actions, or damages that I may have against them arising out of or in any way connected with my
participation in the event. I understand that this waiver includes and claims whether caused by negligence, the
action or inaction of any of the above parties, or otherwise. 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, motion pictures, web site images, recordings, or any other record of this event.
Signature ___________________________________________ Date___/___/___
(Parent, if under 18 years of age)
Mail to: Pine Belt Pacers, P.O. Box 1171, Hattiesburg, MS 39403-1171
Thursday, May 2, 2013
6:30 p.m.
Kamper Park
(107 17th
Avenue, Hattiesburg)
*A STATE-WIDE ‘RUN FOR BOSTON’ EVENT*
Description: Running groups throughout
Mississippi (and some from Louisiana) are
joining forces to run 2.62 miles in their respective
communities at 6:30 on Thursday, May 2. The
run will be preceded by a moment of silence at
6:25 to honor the events of April 15th. Food and
beverage will be provided; please feel free to
bring a covered dish to share. Join us as
Hattiesburg runs/walks/bikes for Boston!
Registration:
 $20 Registration & dry-fit T-shirt
 $10 Registration, no T-shirt
Registration should be post-marked by 4/29
Day of Registration: Begins at 5:30
Additional donations will also be accepted.
All proceeds from the event will be donated
to the One Fund Boston to help victims.
2.62 BOSTON STANDS AS ONE
A 2.62 Mile Run Benefitting the One Fund Boston