2016 Val Brochure
SEROOGY’S VALENTINE Run • Sat., Feb. 6 @ 8 a.m. To Benefit: St. Norbert T.R.I.P.S. program CHECK ONE: 15K_____ 5K_____ First___________ Last___________________________ D.O.B ____/____/____ Age___ Female____ Male____ E-mail _______________________________________ Address______________________________________ City _____________________State_____ Zip_______ Phone ______ - ________ - ________
* Individual entrants use one form per person. This form may be duplicated
Athena (F-165 lbs+)___ Clydesdale (M-220 lbs+)___ (optional) Circle size: Child S (6-8) M (10-12) L (14-16) Adult
S
M
L
XL
XXL
METHOD OF PAYMENT ENCLOSED: Check_______ Visa_______ Mastercard________Cash___ Card no. __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Ex. Date ___ /___ Sig. No. (last 3 on back)___ ___ ___ Fill in Event Fee: _____ Adults: $28 thru Feb. 2, $35 thru Day of Event
6 ’s 1 0 2 gy o ne o r Se lenti lk Va n/Wa Rudutrirun.com
_____ Kids 12 & Under: $18 thru Feb. 2, $20 thru Day of Event
____
Add $2 for XXL shirt
____ -$3 off discount if dropped off at Seroogy’s by 2/3 ____ TOTAL
Registration: Seroogy’s Chocolates
-Title Sponsor-
144 N Wisconsin Ave • De Pere, WI
Feb. 5: 3-6 p.m., Feb. 6: 6:45-7:50 a.m.
Online registration: active.com Make check payable and send to:
-Sponsor-
DuTriRun PO Box 7723 • Appleton, WI 54912
Waiver: I should not enter and compete unless I am medically able and properly trained. I understand a paramedic and ambulance will be available for safety reasons. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act in my behalf waive and release all race officials and agents; the City of De Pere; and all sponsors, their representatives and successors from all claims or liabilities arising out of my participation in this event.
* Individual entrants use one form per person. This form may be duplicated
Athena (F-165 lbs+)___ Clydesdale (M-220 lbs+)___ (optional) Circle size: Child S (6-8) M (10-12) L (14-16) Adult
S
M
L
XL
XXL
METHOD OF PAYMENT ENCLOSED: Check_______ Visa_______ Mastercard________Cash___ Card no. __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Ex. Date ___ /___ Sig. No. (last 3 on back)___ ___ ___ Fill in Event Fee: _____ Adults: $28 thru Feb. 2, $35 thru Day of Event
6 ’s 1 0 2 gy o ne o r Se lenti lk Va n/Wa Rudutrirun.com
_____ Kids 12 & Under: $18 thru Feb. 2, $20 thru Day of Event
____
Add $2 for XXL shirt
____ -$3 off discount if dropped off at Seroogy’s by 2/3 ____ TOTAL
Registration: Seroogy’s Chocolates
-Title Sponsor-
144 N Wisconsin Ave • De Pere, WI
Feb. 5: 3-6 p.m., Feb. 6: 6:45-7:50 a.m.
Online registration: active.com Make check payable and send to:
-Sponsor-
DuTriRun PO Box 7723 • Appleton, WI 54912
Waiver: I should not enter and compete unless I am medically able and properly trained. I understand a paramedic and ambulance will be available for safety reasons. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act in my behalf waive and release all race officials and agents; the City of De Pere; and all sponsors, their representatives and successors from all claims or liabilities arising out of my participation in this event.
