MIRACLE ON MAIN STREET

Jingle Bell Fun Run 1.9 Mile Family Friendly Course

Saturday, December 8, 2012 Contact: Angie Duffner - days (509)989-3319 Wendy Bilodeau - evenings (509)787-7129 Time: Registration is from 10:00–10:55 am at AmericanWest Bank, 261 Basin Street SW

Runners will assemble at 10:55 for pre-race instructions. Race starts promptly @ 11:00 am.

Entry Fee: Advanced Registration: $18 per adult/$15 (17 and under) NO SHIRT $12 Family Entry Fee: $60 for family of four (Pre-registration only) $12 each additional family member

(ADVANCE REGISTRATION MUST BE RECEIVED BY MONDAY, DECEMBER 3RD, TO GUARANTEE T-SHIRT ON RACE DAY)

DAY OF RACE: $21 per adult (NO SHIRT $15) $18 (17 and under) Please make checks payable to: Ephrata Chamber Commerce, PO Box 275, Ephrata, WA 98823 (All fees non-refundable)

***ENTRY FORMS MUST ACCOMPANY PAYMENT***

Course and Distance: The race will begin on Basin Street at AmericanWest Bank. A family friendly, all pavement, 1.9 mile

course down Basin Street, left at Lee Theater (4th

Ave), left on C Street, left onto 3rd

Ave, ending in Subway parking lot. Facilities: First aid available on the course and at the finish line. Restroom facilities available in Subway and at ERC.

Age Divisions: 0-5; 6-9; 10-13; 14-17; 18-20; 21-29; 30-39; 40-49; 50-59; 60-69; 70+ Awards: T-shirt to all finishers with advance registration. Small prize to top male and female in each category.

***RETURN THIS SECTON WITH ENTRY FEE TO RACE DIRECTOR*** (Mail to Ephrata Chamber of Commerce, PO Box 275, Ephrata, WA 98823 or drop off forms at City Hall)

PLEASE PRINT CLEARLY: NAME: ____________________________________________________________________ SEX (M/F) ___________

ADDRESS: _______________________________________________ CITY_______________________ ZIP ________

AGE ON DAY OF RACE: _________ PHONE: ( )____________________

T-SHIRT SIZE: YM ____ YL____ AS ____ AM____ AL ____ AXL____ AXXL____ WAIVER: In consideration of your accepting my/my child’s entry, I hereby consent to participation in the herein described activities by the child named herein and I hereby, for myself, my child, my heirs, executors

and administration to hereby expressly and forever waive and release any and all claims against and agree to hold harmless the City of Ephrata, Ephrata Chamber, City of Ephrata Recreation Department, Ephrata School District 165 and all their respective officers, employees, agents, representatives, successors, or assigns of any kind from any and all claims which may be made for damages and/or injury to property or persons occasioned by any cause whatsoever, arising as a result of or in connection with the participation of me or my child in the herein mentioned activity. By participating in the herein mentioned activity, I, or my child understand the potential risk for injury. I also agree to allow any photos or pictures taken during the activities to be used in promotions or activities offered by the City of Ephrata of Ephrata Chamber.

Signature: ________________________________________________________________ Date: _____________

(Must be signed to run) Parent’s Signature: ________________________________________________________ Date: _____________

(If under age 18)