Little Lei Lei's 5K Memory Walk

On May 14th, we will be having Leightyn's 5K Run and Memory Walk benefiting the Children's Emergency Shelter of Fort Smith. If you would like a Registration form, please message me your email address. Pre-regristration ends April 29th. You may register up until race day. The race will be help at Ft. Chaffee. Door Prize drawings will be help for participants of the 5K. Let me know if you have questions!

I can not figure out how to link the Word document to the blog. So, below is the entry form. You can copy and paste it to Word or email me at mdb9191@yahoo.com or leightynslifesong@yahoo.com and I will email you the form.

Thanks!


Little Lei Lei’s 5k Run and Memory Walk
Benefiting the Children’s Emergency Shelter of Fort Smith
Race Day - Saturday, May 14, 2011
Start Time 8:00AM
Race Will Be Held At Ft. Chaffee (Begins on Ft. Smith Blvd)
One form per participant.

Name: _____________________ Email ___________________
Street Address ______________________ City ______________
State ________ Zip ________ Phone Number ________________

Entry Fee: Pre-registration Ends April 29th, 2011
____ 5K ($25) ____ 1 Mile Walk ($10) ___1 Mile Family of Four ($30)
After Pre-Registration and Day of Race
____ 5k ($30) ____ 1 Mile Walk ($15) ___ 1 Mile Family of Four ($40)

Shirt Size (Circle One)
YXS YS YM YL AXS AS AM AL AXL AXXL

Make Checks Payable to Children’s Emergency Shelter Amount ______
All Pre-Registrations Received By April 29th Will Receive A T-Shirt!!
Early Check-In Friday, May 13, 2011 4pm-7pm at Sweet Bay Coffee at Creekmore Park
Check-In Day of Race Begins at 7:00am
Medals will be given to overall 1st, 2nd, 3rd in 5K
Door Prize Drawings will be for participants of 5K

Waiver and Release of Claims: I understand that my consent to these provisions is given in consideration of the acceptance of this registration and for being permitted to participated in this event. I am a voluntary participant in this event, and in good physical condition. I know that this event is a potentially hazardous activity and I hereby assume full and complete responsibility for injury or accident which may occur during my participation in this event or while on the premises of this event, and I hereby release and hold harmless and covenant not to file suit against The Children’s Emergency Shelter or Landen and Melissa Holmes, and any affiliated individuals, Little Lei Lei’s 5k, ArkansasRunner.com, any race sponsors and their agents and employees, and all other per- sons or entities associated with this event (the “Releasees”) from any loss, liability or claims I may have arising out of my participation in this event, including personal injury or damage suffered by me or others, whether the same be caused by fall, contact with participants, conditions of the course, negligence of the Releasees or otherwise. If I do not follow all the rules of this event, I understand that I may be removed from the competition.

Participant’s Signature _______________________________________________

Parent/Guardian (if participant is under 18) ______________________________________

Date ________________________


Mail Form to: 9804 East Pointe Drive, Fort Smith, AR 72903
For More Information Call: (Missy) 479-461-3997 or (Landen) 479-414-8892
Email At mdb9191@yahoo.com