Shalom: A Day of Health and Wellness

5K Run - 5K Walk

Saturday, October 24, 2009, 6:30 am start time
Jackson Convention Complex, 105 E. Pascagoula Street, Jackson MS

*Pre-Registered Racers will receive a FREE pedometer and T-shirt.
Awards will be given to the overall winners, male and female in appropriate age groups.

For more information send email to CUMCFLCDirector@yahoo.com or call 601.355.7858.

Registration Information

Name _____________________________________ Gender: M / F

Address ______________________________________________

Email _____________________ Shirt Size: YXL AS AM AL AXL AXXL

Home Phone (____)__________ Cell Phone (____)_________ Age___

Signature_________________________ Date__________________

Pre-Registration Fee $10 Pre-Registration Deadline: October 10, 2009
Registration Fee $20 after October 10, 2009
Race Day Registration $30
Please make checks payable to Central UMC and send registration form to
Central United Methodist Church Family Life Center
517 N. Farish Street Jackson MS 39202

I, the signee above, and representatives knowingly waive, release, and forever discharge all rights and claims which it may hereafter accrue as a result of the services provided by Central United Methodist Church and its associations (Entities). Any and all injuries or death suffered during this event are not the responsibility of the Entities. The signee and its representatives knowingly assume all risk involved in this event. All participants must complete a registration form. The signee and its representatives will allow the Entities to use event pictures, comments, and media at their discretion. I realize that the event may be subject to cancellation at the discretion of the Run Committee and that my registration fee is non-refundable. All documents, cost, and any other proprietary information concerning this event are the sole ownership of the Entities.