Meet Information
2nd Annual BCC 5K and 1 mile Fun Run/Walk
Family Night at the Bradenton Country Club
Supporting PACE Center for Girls
Friday, October 14th, 2011 6:15 p.m.
Run/Walk the Beautiful Country Club course!
Bring your swimsuits, appetite, and the entire family!!
Location: Bradenton Country Club 4646 9th Ave. W. Bradenton, Fl 34209
Schedule: 5-6:10 p.m. Goodie bags and registration (T-shirts guaranteed to first 100)
6:15 p.m. Start of 5K Run/Walk
6:20 p.m. Start of 1 mile Run/Walk
6:45 p.m. Post-race fun (food, door prizes, swim, awards )
Registration: Registration and Post-Race Party by the pool. Please register and mail in
the bottom portion with your payment. Visit www.bodybykim.com for more forms.
On-Line registration: www.runsignup.com (search: BCC)
Entry fee: (includes shirt (first 100 guaranteed), goodie bag, food, and drinks)
Before Oct. 7th BCC, BRC, Striders, PACE board members: $20 After Oct. 7th: $25
Before Oct. 7th Non-members and/or Guests:
$25 After Oct. 7th: $30
Awards: 5 K Overall male & female winners! Ribbons to all 1 mile participants.
____________________________________
Registration Form
Please make checks payable to: Bradenton Country Club
Mail to: Attn: Kim Thomas/BCC 4646 9th Ave. W. Bradenton, Fl 34209
Participant Name: __________________________________________
Address:
__________________________________________
Cell Phone/E-mail:__________________E-mail: ________________
Date of Birth:
__________________ Gender: ________________
Age on Event Day: ___________________Amount Enclosed $_______
Shirt Size: (circle one) XXL
XL
L
M
S
I, self or as guardian or parent of the above mentioned participant(s), hereby release, hold harmless and forever discharge the
Bradenton Country Club, Inc. (BCC) (including employees), the Fitness Director (including participants), and the any and all
persons associated with the BCC. of all liabilities, claims, actions, damages, costs, expenses which I, or the participant may
have against them arising out of or in any way connected with the participants participation in this event, including injuries
which may be suffered before, during, or after any BCC event. I understand the waiver includes any claims based on
negligence, action or inaction or any of the above parties, their agents or representatives. I also understand that BCC does
not carry personal injury or bodily injury coverage on event participants. I, self or as guardian or parent of the above
mentioned participants(s), have read and voluntarily signed this release and waiver of liability with the express
acknowledgement and agreement that the above mentioned participant is engaging in dangerous activity which involves risk
of serious injury and/or death.
Participants Signature ____________________ (parent or guardian if under 18 yrs.)
Date: _______________________
Official Use Only: Bib # _________
Family Night at the Bradenton Country Club
Supporting PACE Center for Girls
Friday, October 14th, 2011 6:15 p.m.
Run/Walk the Beautiful Country Club course!
Bring your swimsuits, appetite, and the entire family!!
Location: Bradenton Country Club 4646 9th Ave. W. Bradenton, Fl 34209
Schedule: 5-6:10 p.m. Goodie bags and registration (T-shirts guaranteed to first 100)
6:15 p.m. Start of 5K Run/Walk
6:20 p.m. Start of 1 mile Run/Walk
6:45 p.m. Post-race fun (food, door prizes, swim, awards )
Registration: Registration and Post-Race Party by the pool. Please register and mail in
the bottom portion with your payment. Visit www.bodybykim.com for more forms.
On-Line registration: www.runsignup.com (search: BCC)
Entry fee: (includes shirt (first 100 guaranteed), goodie bag, food, and drinks)
Before Oct. 7th BCC, BRC, Striders, PACE board members: $20 After Oct. 7th: $25
Before Oct. 7th Non-members and/or Guests:
$25 After Oct. 7th: $30
Awards: 5 K Overall male & female winners! Ribbons to all 1 mile participants.
____________________________________
Registration Form
Please make checks payable to: Bradenton Country Club
Mail to: Attn: Kim Thomas/BCC 4646 9th Ave. W. Bradenton, Fl 34209
Participant Name: __________________________________________
Address:
__________________________________________
Cell Phone/E-mail:__________________E-mail: ________________
Date of Birth:
__________________ Gender: ________________
Age on Event Day: ___________________Amount Enclosed $_______
Shirt Size: (circle one) XXL
XL
L
M
S
I, self or as guardian or parent of the above mentioned participant(s), hereby release, hold harmless and forever discharge the
Bradenton Country Club, Inc. (BCC) (including employees), the Fitness Director (including participants), and the any and all
persons associated with the BCC. of all liabilities, claims, actions, damages, costs, expenses which I, or the participant may
have against them arising out of or in any way connected with the participants participation in this event, including injuries
which may be suffered before, during, or after any BCC event. I understand the waiver includes any claims based on
negligence, action or inaction or any of the above parties, their agents or representatives. I also understand that BCC does
not carry personal injury or bodily injury coverage on event participants. I, self or as guardian or parent of the above
mentioned participants(s), have read and voluntarily signed this release and waiver of liability with the express
acknowledgement and agreement that the above mentioned participant is engaging in dangerous activity which involves risk
of serious injury and/or death.
Participants Signature ____________________ (parent or guardian if under 18 yrs.)
Date: _______________________
Official Use Only: Bib # _________