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Benefit for The PediatricSickle Cell Program

Date(s): 9/21/2013

7:00am

Northeast Park 7300 Newell Road Meridian, Mississippi
Help Stop the Pain Step Up for Sickle Cell
Walk-A-Thon
September 21, 2013
Proceeds will benefit The Pediatric Sickle Cell Program at UMMC, Along with the Mississippi Sickle Cell Foundation.

Send entry forms and fee to:
Attn: Geneva Burton, GDWM
The Seventh District, Order of Eastern Star
P.O. Box 34
Toomsuba, MS 39364

Make checks payable to 7th District O.E.S.

Walk-A-Thon Details
Location:
Northeast Park
7300 Newell Road
Meridian, Mississippi

IN CASE OF RAIN EVENT WILL BE AT THE BOYS & GIRLS CLUB


Registration: 7:00am
Event Start: 7:30am

Course:
The course is the track. The Fun Run will begin after the 5k. The course will have aid stations and mile splits.

Entry Fee:
$15 per walker(includes a T-Shirt)

5K Walker
(For adults ages 16 years and above)

1Mile Fun Run:
(Limited to 15 years of age and under)

Awards:
Door prizes will be given away
Special prizes will be given to winners
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Registration Form
"Help Stop the pain Step up for Sickle Cell 5K Walk"

Circle Event: 5K Walk 1 Mile Fun Run

Name:______________________________Age____Sex:______

Address:_______________________________________________

City:____________________________State:_____Zipcode_______

Home Phone:__________________Work Phone:_______________

T-Shirt Size (circle one): Youth L Adult S Adult M Adult L Adult XL Adult XXL Adult XXXL

I herby certify that I am adequately to fit to walk in this race. In consideration or the acceptance of this entry, I , the undersigned, for myself, my, my personal representative, beneficiaries, and heirs, knowingly waive, release, and discharge any and all rights and claims which I have or may have hereafter accrue to me or my estate against the Mississippi Sickle Cell Foundation, The University of Mississippi Medical Center, Bathsheba Grand Chapter, Order of Eastern Star, its subordinate Chapters, members, and/or any other sponsors, organizers, volunteers, and assign for any and all injuries or deaths, suffered by me in this event. I will also allow my picture to be used in publication as a result of this race/walk/event.

Signature__________________________Date_________________

Relationship(if minor)_________________________________

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