2015 Leadership Road Race Registration Form

Leadership Road Race Logo

2015 Leadership Road Race

DATE: April 11th, 2015
LOCATION: Southwestern College, Winfield, KS
DISTANCES: 1 Mile Family or Certified 5K course

SCHEDULE:
Certified Non-color 5K and 1 Mile: 8:30 a.m.
Color Edition 5K and 1 Mile: 10:00 a.m. (NO PETS ALLOWED)
 

Entry Fees

5K NON-COLOR ENTRY FEES:
Postmarked on or before March 27th: $20.00
Postmarked later or Race Day: $25.00

1 MILE NON-COLOR ENTRY FEES:
Postmarked on or before March 27th: $12.00
Postmarked later or Race Day: $15.00

5K COLOR EDITION ENTRY FEES:
Postmarked on or before March 27th: $30.00
Postmarked later or Race Day: $35.00

1 MILE COLOR EDITION ENTRY FEES:
Postmarked on or before March 27th: $15.00
Postmarked later or Race Day: $20.00

CHILD DISCOUNT:
Children 8th grade and younger receive a $3 discount on all runs. Must register on or before March 27th to receive discounted rate.

RACE PACKETS:
Packets will be available the day of the race. If needed before race day, please contact us.

COLOR EDITION:
Come ready to "Get Colorful!!" and support SC Leadership! Pets are not welcome for the color edition races and it is sure to be fun for the whole family. T-shirts will be guaranteed to all runners who sign-up prior to the March 27th early-bird deadline

Biographical Information

Last Name  
First Name  
Street Address  
City  
State  
Zip Code  
E-mail Address  
Phone Number (Please include area code)  
Gender  Male
 Female
Birth Date  
Age on Race Day  
Are you registering as a group with a company, organization or team?  If so, please indicate company/organization name:  
Shirt Size
(Guaranteed if registered by March 27)

S
M
L
XL
XXL
Event(s) of Participation 5K Certified Non-color
1 Mile Certified Non-color
5K Color Edition
1 Mile Color Edition
I will be bringing a pet to the Non-color 1 Mile Family/Pet Jog Yes

Student Credit

If desired, please specify a student name to receive
credit for this registration.

Payment

Please make checks payable to:  Southwestern College Leadership

Send to:

Southwestern College
Attn. Leadership Road Race
100 College St.
Winfield, KS 67156

Signature

In consideration of my entry being accepted I, intending to be legally bound, do hereby waive, release, and forever discharge any and all rights and claims for damage which hereafter occur to me against Leadership Southwestern, Southwestern College, and all sponsors, volunteers for any injuries suffered by me against this event. I further state that I am in proper physical condition to compete in this race.

By typing my name in the Signature textbox below and submitting this online form I certify under penalty of perjury that all information provided is correct and complete and I agree to the terms and conditions of the waiver stated above.

Signature:

Signature of Parent/Guardian (if under 18):     

Date:

Southwestern College is committed to a policy of nondiscrimination on the basis of race, color, gender, age, religion, national origin, handicap, or other nonmerit reasons, in admissions, educational programs or activities, and employment, all as required by applicable laws and regulations. Responsibility for coordination of compliance efforts and receipt of inquiries, including those concerning Title IX of the Education Amendments of 1972 and Section 504 of the Rehabilitation Act of 1973, has been delegated to the vice president for business affairs, Christy Administration Building, Southwestern College, 100 College Street, Winfield, KS 67156-2499, (620) 229-6000. Southwestern College complies with the Crime Awareness and Campus Security Act of 1990. The yearly report is available from the dean of students upon request. Race and ethnic origin information is voluntary and will not be used in a discriminatory manner.