Come and Join us for the 5^th Annual
5K Memorial Day Run/Walk

In Memory of Cpl. Joseph P. Micks   “Our Local Hero”

         When:  Memorial Day, May 28^th, 2012                      Entry Fees:  $20.00

        Where:  Rapid River Lion’s Club Pavilion                    $15.00 each for family of 3 or more
                      Rapid River, Michigan                                    $2.00 UPPRC Discount        

Registration: 7:00 to 8:45 am                                           Start Time:  9:00 am EST

 Awards:  Over all Male and Female Runners receive a Trophy.
                 The top 2 winners in each age category and gender receive a Medal.

 Age Divisions: 10 and Under, 11-14, 15-19, 20-29, 30-39, 40-49, 50-54, 55-59, 60-64, 65 and Over.

 Pre-Register by May 1^st to guarantee a T-Shirt

Mail this Regisration Form with Payment to:   Run for Joe
                                                                    PO Box 352
                                                                    Escanaba, MI  49829

Waiver:  In consideration of this entry, I, intending to be legally bound, hereby, for myself, my heirs, my executor and administrators, waive and release the Run for Joe Committee, the Rapid River Lion’s Club, the City of Rapid River, sponsors, and their representatives, successors and assigns from any and all rights and claims for danger I may have arising out of any injuries and illnesses suffered by me in this event, including those which may attributed to weather conditions.  I attest and verify I will participate in this event as foot race, that I am physically fit and have sufficiently trained for the completion of this event and a licensed medical doctor has verified my physical condition.  I have read this entry information and certify my compliance by my signature below.

 I also understand that my entry fees I pay are NON-REFUNDABLE.   (Parent or guardian must sign if participant is under 18 years of age.)

 Name:______________________________________________________________________
               Last Name           (Please Print Clearly)        First Name                                         Phone

Address:_____________________________________________________________________
                                                                         City                   State            Zip Code

Age on May 28th, 2012:_____________      Gender:  Male_________   Female__________

Event:  5K Run_______ 5K Walk_______T-Shirt Size (please circle one):  S  M  L  XL  2XL

Signature:________________________________________   Entry Fee:________________
Information:  Amy Micks 906-474-9001