Entry form

Make checks payable to:
Grace Baptist Church
Mail form and entry fee to:
Phone: 864-888-0703
Email: blake_pitts@yahoo.com
Race For Grace
Grace Baptist Church
15195 Wells Highway
Seneca, SC 29678
Date: June 11, 2011
Location: Start and finish will be at the Seneca High School Football Stadium
Starting Time: The 1 mile Fun Run will begin at 8:00 am, and the 5K Road Race will begin
at 8:30 am.
Packet Pick Up: Packets can be picked up at Grace Baptist Church from 5:00 pm to 7:00 pm
on Friday, June 10th and from 7:00 until 7:30 am on June 11 at the race site.
Race Results: Results will be posted on www.scrunners.com the day of the race.
Registration: Entry form is below. Please mail entries to:
Race For Grace
15195 Wells Highway
Seneca, SC 29678
Race for Grace 5K (T-Shirt): Registered runners/walkers $15.00 if postmarked before June
1st or $20.00 after June 1st.
Joyce Gaines One Mile Fun Run (T-shirt available for purchase): $10.00 to walk/run
with t-shirt purchase available for $5.00.
Registration Information:
Name _____________________________ Date of Birth ___________________
Age on June 11, 2011_______ Gender: M or F
Address ________________________________
City _____________________ State _______ Zip Code _______________
Emergency Contact __________________________ Phone Number ______________________
I am planning to run:
_____ Race For Grace 5K Run (Please enclose a check for $15.00 if postmarked before June 1st or $20.00 after June 1st.)
_____ Joyce Gaines 1 Mile Fun Run (Please enclose a check for $10.00 plus $5.00 if you wish to purchase a t-shirt
Waiver: In acceptance of entry, I for myself, my heirs and assigns release Grace Baptist Church , Seneca High School,
the City of Seneca, Oconee County, sponsors and volunteers from any liability arising from illness, injury or damages
that I may suffer as a result of my participation in, traveling to, or traveling from this event. I realize that this is a strenuous
event that requires proper physical conditioning. I hereby certify that I am in such physical condition and good
health. I know that there may be traffic on the course. I assume the risk of this event. I also give my permission for free
use of my name and picture in broadcast, telecast or written account of the event. I understand that my entry fee is nonrefundable.
Printed Name __________________________________ Signature ____________________________ Date ________________
Race for Grace