Information: All applicants that register before Wednesday, March 26th, will receive a race t-shirt. Other applications received after this date will be accepted up until race day. Extra t-shirts can be purchased for $15 each on day of race (Call 770-540-5735 to pre-order additional t-shirts).Awards will be given to the top three male and female winners! Look us up on Facebook: Relay For Life of Jefferson County, GA. All proceeds from the race will benefit the American Cancer Society, Relay for Life of Jefferson County. This is a pet-friendly event (must be on a leash).

Complete the following:

Name: _____________________________________________

Address: ___________________________________________

City: ______________________ State: _____ Zip: __________

Telephone: _________________ Email Address: __________________________

Sex (circle one) M     F     Date of Birth: __________ Age: _____

T-shirt size (circle one) Adult:  XS  S   M   L   XL   XXL 

Entry Fees:

Early registration (includes t-shirt)$20

Late registration (does not include a t-shirt) .$20

*Ages 12 and under get in for free

You may mail your completed application and fees, no later than  March 31st, to: Frances Cooper, Attn: 5K Run, P.O. Box 596, Wadley, GA or you may drop applications off at the North Jefferson Family YMCA in Wrens.

Checks can be made out to: American Cancer Society

Waiver

I know that participating in this race is a potentially hazardous activity. I should not enter unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to complete it safely. I assume all risks associated with participating in this event including, but not limited to: falls, contact with other participants, the effects of weather, traffic, and conditions of the paths and roads, all such risks being known and appreciated by me. Having read this waiver, I, for myself and anyone entitled to act on my behalf, waive and release American Cancer Society, Relay For Life of Jefferson County Committee, Jefferson County School Systems, Wrens Baptist Church, the City of Wrens, the County of Jefferson, the State of Georgia, North Jefferson Family YMCA and all sponsors, their representatives and successors, from all claims or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence on the part of the persons named in this waiver.

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Signature of Participant                                                                                                Date

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Parents Signature, if under age 18                                                                               Date