521 Bird St. • Benton 501-778-7144
“Family Owned & Operated” Serving Saline County for over 60 years
Residential & Commercial 778-4646 www.middlebrookselectric.com
#3 Medical Park Dr Suite 201 Benton, AR 72015 501.778.3361
Bo Baxley
501-860-5000
www.regions.com
Coming Soon to our Community! Educational Dinners & Lunches Topics Include: Epilepsy, High Blood Pressure, Diabetes, Depression & More Contact Civitan Services’ Nurse Shannon for dates and times of training
Sponsored By:
Saturday, March 14, 2015
All proceeds benefit
1 Mile Family Fun Run 7:00 AM 5K Run/Walk 8:00 AM Awards to Follow 5K
Serving the men, women and children living with developmental disabilities in Saline County for over 50 years.
Early Packet Pick-Up & Pasta Dinner Friday, March 13 6:00-8:00 PM FREE food for race participants at The Civitan Center 121 Cox St. Benton, AR 72015
Race Day Registration & Packet Pick-Up March 14 6:15 - 7:45 AM at The Civitan Center 121 Cox St. Benton, AR 72015
One entry form per person. Please Print.
Name: ________________________________________________________________________________ Male
Female
5K Run/Walk
Date of Birth:_____/_______/________ Age on 3/14/15: ____________
1 Mile Fun Run
Spirit Runner (unable to attend, but donating to the cause & will get a t-shirt)
Address:______________________________________________________________________________ City: __________________________________________
State: ___________ Zip:____________
E-Mail: _______________________________________________________________________________ T-shirt Size (please circle one):
YS
YM
Shirt sizes only guaranteed to participants that register by February 28th
YL
S
M
L
XL
2XL
3XL
Release:
I know that running/walking in a 5K race is a potentially hazardous activity. I should not enter nor run in this race unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run/walk. I assume all risks associated with running and volunteering to work in The “Peace, Love & 5K” including, but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity, the condition of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release Civitan Services, The Benton Civitan Club, the City of Benton, Benton Public Schools, ArkansasRunner. com and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in the race even though liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose.
Signature: _______________________________________________ Date:__________________ Parent Signature if under 18 _________________________________________________________ Entry Fees: Early Registration by February 28, 2015 Registration after February 28, 2015 5K Run/Walk (with a t-shirt)- $20 5K Run/Walk (with a t-shirt)- $25 Spirit Runner (with a t-shirt)- $20 Spirit Runner (with a t-shirt)- $25 1 Mile Fun Run (with a t-shirt)- $10 1 Mile Fun Run (with a t-shirt)- $15 1 Mile Fun Run (without a t-shirt)- FREE 1 Mile Fun Run (without a t-shirt)- FREE Race Description: 1 Mile Fun Run- Race will be held on the Benton High School track inside 4 lanes and all finishers will get a prize. 5K- Race will begin at The Civitan Center, continue out the Benton Parkway to a turn around and end in the new Benton High Sports Complex. This is the same course as past years and Gary Ballard of arkansasrunner.com has measured and will be timing the race. This is a flat and fast course! Prizes will be awarded to Age Group Winners, both male and female. Register and Pay Online securely at www.civitanservices.com For Information, call 501-776-0691 or E-mail acopple@civitanservices.com
Make checks payable to “Civitan Services” Write “5K” on the memo line Mail to: Civitan Services 121 Cox St. Benton, AR 72015