$15

$15.00 Registration fee**

add $5.00 late fee if received after November 18, 2010

**T-shirt included in fee (Add $1.50 per shirt for XXL or larger sizes)

Make checks payable to: Trinity United Methodist Church

P.O. Box 9, Moberly MO. 65270

Name: _________________________________________

Address: _______________________________________

City: ____________ State: _________ Zip: ___________

Phone: (Home) ________________ (Work) ____________

Male_____ Female ______ Age on race date: ___

T-shirt Size: S M L XL XXL**

Please check event you wish to enter: 5K Run___ 5K Walk _______

Waiver: I know that running a road race is a potentially hazardous activity and that I should not enter and run unless I'm medically able and properly trained. I also know that, although police protection will be provided, there will be traffic on the course. I assume the risk of running in traffic. I also assume any and all other risks associated with running this event including but not limited to falls, contact with other participants, the effects of the weather and the conditions of the roads, all such risk being known and appreciated by me. I hereby relinquish any and all claims for myself, my heirs, executors and administrator, waive, release and forever discharge any and all rights and claims for damages I may have against the sponsors of the Thanksgiving Day 5K Run, Trinity United Methodist Church, Wal-Mart Distribution Center, the City of Moberly, and all other sponsoring agencies, their representatives, successors, and assignees for any and all injuries suffered by me in said event.

Signature: ______________________________ Date: __________________

(Parent/Guardian if under 18 years of age)

For more information call

(660)-263-6863

Or go online at