NRV Airport Runway 5K Race and 1 Mile Fun Run Registration Form
Sunday, September 25, 2016 at the NRV Airport 5391 C.V. Jackson Road, Dublin, VA 24084.
Fun Run/Walk at 6:30 PM. 5K Race at 7:00 PM. Rain date October 2 nd same times.
5K Race has a $20 registration fee before September 20 th or $25 on race day Sept. 25th .
T-Shirt on race day included for first 100 to register. T-shirts for others will be available for
pick-up after race day.
No registration fee for 1 Mile Fun Run/Walk. Optional T-shirt can be purchased for $10.
Entering (circle one): 5 Kilometer (3.1 mile) Race
1 Mile Fun Run/Walk
$10 T-shirt Yes
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Last Name
No
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First Name
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Mailing Address
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Email Address
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Preferred adult t-shirt Size
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Age (on Sept. 25, 2016)
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Signature
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Signature of parent or guardian for participant under age 18
Enclose a check of $20 per 5K Race participant or $10 for Fun Run with optional T-shirt
payable to: PCHS Cross Country Boosters. Mail check and registration form to:
PCHS Cross Country Boosters
Pulaski County High School
Attn: Scott Vest
5414 Cougar Trail Road
Dublin, VA 24084