ist annual debbie burchettstorage.googleapis.com/wzukusers/user-12848592/documents/... · web...
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![Page 1: Ist Annual Debbie Burchettstorage.googleapis.com/wzukusers/user-12848592/documents/... · Web viewUSATF certified and sanctioned 5K road course through Clemmons West Subdivision](https://reader035.vdocuments.site/reader035/viewer/2022070610/5afaf3437f8b9ad2208fe843/html5/thumbnails/1.jpg)
Course: USATF certified and sanctioned 5K road course through Clemmons West Subdivision. Easy to moderatre course with only a couple of mild hills. Start and finish at Clemmons West Swimming Pool.
Finish line managed by Twin City Track Club.
Directions:I-40 West to Clemmons exit. Left at light, Clemmons West Pool is approximately 1 ¾ miles on right.
Parking: Across Middlebrook Drive at Hayward Industries parking lot.
Registration: Via mail or www.active.com
$25.00 Until May 9
$30.00 After May 9 and race day
$12.00 Fun run/walk until May 9
$15.00 Fun run/walk after May 9
T-Shirts: T-Shirts guaranteed to the first 200 entrants (5K & Fun run/walk). Packet Pick-up: Friday, June 5, 5:30 pm – 8:00 pm at Clemmons United Methodist Church Fellowship Hall, 3700 Clemmons Road (US 158) Race day 7:00 am – 7:45 am at Clemmons West Pool Shelter.
Start Times:Fun run/walk, 8:15 am. 5K, 8:30 am
Awards:*Awards immediately following the completion of the 5K at the pool shelter as follows:
Overall:Top 3 males and femalesAnd male and female master and grand master
Age Groups: Top 3 males and females in each division. 12 & under, 13-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-65,66 & over.
Fun Run: Top male and female 13 and up. Top male and female 12 and under. * No duplication of awards
Post-Race Refreshments: Refreshments will be available beginning approximately 9:00 am at the pool shelter.
Additional Information: Call 336-766-0385
The Debbie Burchett Endowment Fund
The Debbie Burchett Endowment Fund is a permanent endowment that was created in the
Nam
e:__
____
____
____
____
____
____
____
___
Rac
e en
teri
ng: 5
K__
__ F
un ru
n/w
alk:
____
Add
ress
:___
____
____
____
____
____
____
____
_ P
hone
:___
____
____
__C
ity:_
____
____
____
____
____
____
Sta
te:_
___
Zip
Cod
e:__
____
____
_ E
-Mai
l :__
____
____
____
____
_
T-Sh
irt S
ize:
M__
L__
XL_
_
Sex:
M__
F__
B
irth
Dat
e:__
____
____
__ A
ge o
n R
ace
Day
:___
__
Ent
ry F
ees:
5K
bef
ore
May
9, $
25.0
0, a
fter,
$30.
00
M
ake
chec
ks p
ayab
le to
: SFC
5k
F
un ru
n/w
alk,
bef
ore
May
9, $
12.0
0,af
ter,$
15.0
0
T
otal
Enc
lose
d:$_
____
_
RA
CE
WA
IVER
: I k
now
that
runn
ing
a ro
ad ra
ce is
a p
oten
tially
haz
ardo
us a
ctiv
ity. I
sho
uld
not e
nter
and
run
unl
ess
I am
med
ical
ly a
ble
and
prop
erly
trai
ned.
I ag
ree
to a
bide
by
any
deci
sion
of
a ra
ce o
ffici
al re
lativ
e to
my
abili
ty to
saf
ely
com
plet
e th
e ru
n. I
assu
me
all r
isks
ass
ocia
ted
with
run
ning
in th
is ra
ce, i
nclu
ding
, but
not
lim
ited
to, f
alls
, con
tact
with
oth
er p
artic
ipan
ts, t
he e
ffect
s of
th
e w
eath
er in
clud
ing
high
hea
t and
hum
idity
, tra
ffic,
and
the
cond
ition
s of
the
road
, all
such
ris
ks b
eing
kno
wn
and
appr
ecia
ted
by m
e. H
avin
g re
ad th
is w
aive
r an
d kn
owin
g th
ese
fact
s an
d in
co
nsid
erat
ion
of y
our
acce
ptin
g m
y en
try,
I fo
r m
ysel
f and
any
one
for w
hom
I am
ent
itled
to a
ct, w
aive
, rel
ease
, and
will
hol
d ha
rmle
ss th
e C
lem
mon
s St
ride
for
Cou
rage
5K
com
mitt
ee, a
ll ot
her
spon
sors
, and
all
the
agen
ts, e
mpl
oyee
s, of
ficer
s, di
rect
ors
and
volu
ntee
rs w
orki
ng fo
r th
ose
entit
ies
from
all
clai
ms
and
liabi
litie
s of
any
kin
d ar
isin
g ou
t of o
r re
late
d to
my
part
icip
atio
n in
this
ra
ce. I
und
erst
and
that
hea
dpho
nes,
bab
y jo
gger
s or
stro
llers
, rol
ler
skat
es a
nd d
ogs
are
not a
llow
ed in
this
eve
nt u
nles
s exp
licitl
y au
thor
ized
by
the
race
org
aniz
er.
Sign
atur
e (p
aren
t or g
uard
ian
if un
der 1
8):
____
____
____
____
____
____
____
____
____
____
____
___D
ate:
____
____
__ E
mer
genc
y C
onta
ct:
Nam
e:__
____
____
____
____
____
____
____
_ Ph
one:
____
____
____
___
M
ail t
o : S
tride
for C
oura
ge 5
K,
732
La V
ale
Driv
e, C
lem
mon
s, N
C 2
7012
Nam
e:__
____
____
____
____
____
____
____
___
Rac
e en
teri
ng: 5
K__
__ F
un ru
n/w
alk:
____
Add
ress
:___
____
____
____
____
____
____
____
_ P
hone
:___
____
____
__C
ity:_
____
____
____
____
____
____
Sta
te:_
___
Zip
Cod
e:__
____
____
_ E
-Mai
l :__
____
____
____
____
_
T-Sh
irt S
ize:
M__
L__
XL_
_
Sex:
M__
F__
B
irth
Dat
e:__
____
____
__ A
ge o
n R
ace
Day
:___
__
Ent
ry F
ees:
5K
bef
ore
June
8, $
17.0
0, a
fter,
$20.
00
M
ake
chec
ks p
ayab
le to
: DB
BC
F
Fun
run/
wal
k, $
15.0
0
Tot
al E
nclo
sed:
$___
___
RA
CE
WA
IVER
: I k
now
that
runn
ing
a ro
ad ra
ce is
a p
oten
tially
haz
ardo
us a
ctiv
ity. I
sho
uld
not e
nter
and
run
unl
ess
I am
med
ical
ly a
ble
and
prop
erly
trai
ned.
I ag
ree
to a
bide
by
any
deci
sion
of
a ra
ce o
ffici
al re
lativ
e to
my
abili
ty to
saf
ely
com
plet
e th
e ru
n. I
assu
me
all r
isks
ass
ocia
ted
with
run
ning
in th
is ra
ce, i
nclu
ding
, but
not
lim
ited
to, f
alls
, con
tact
with
oth
er p
artic
ipan
ts, t
he e
ffect
s of
th
e w
eath
er in
clud
ing
high
hea
t and
hum
idity
, tra
ffic,
and
the
cond
ition
s of
the
road
, all
such
ris
ks b
eing
kno
wn
and
appr
ecia
ted
by m
e. H
avin
g re
ad th
is w
aive
r an
d kn
owin
g th
ese
fact
s an
d in
co
nsid
erat
ion
of y
our
acce
ptin
g m
y en
try,
I fo
r m
ysel
f and
any
one
for w
hom
I am
ent
itled
to a
ct, w
aive
, rel
ease
, and
will
hol
d ha
rmle
ss th
e D
ebbi
e Bu
rche
tt Br
east
Can
cer
Fund
, all
othe
r sp
onso
rs,
and
all t
he a
gent
s, e
mpl
oyee
s, of
ficer
s, di
rect
ors
and
volu
ntee
rs w
orki
ng fo
r th
ose
entit
ies
from
all
clai
ms
and
liabi
litie
s of
any
kin
d ar
isin
g ou
t of o
r re
late
d to
my
part
icip
atio
n in
this
rac
e. I
unde
rsta
nd th
at h
eadp
hone
s, b
aby
jogg
ers
or s
trolle
rs, r
olle
r sk
ates
and
dog
s ar
e no
t allo
wed
in th
is e
vent
unl
ess
expl
icitl
y au
thor
ized
by
the
race
org
aniz
er.
Sign
atur
e (p
aren
t or g
uard
ian
if un
der 1
8):
____
____
____
____
____
____
____
____
____
____
____
___D
ate:
____
____
__ E
mer
genc
y C
onta
ct:
Nam
e:__
____
____
____
____
____
____
____
_ Ph
one:
____
____
____
___
M
ail t
o : D
BB
CF
5K,
728
La V
ale
Driv
e, C
lem
mon
s, N
C 2
7012
![Page 2: Ist Annual Debbie Burchettstorage.googleapis.com/wzukusers/user-12848592/documents/... · Web viewUSATF certified and sanctioned 5K road course through Clemmons West Subdivision](https://reader035.vdocuments.site/reader035/viewer/2022070610/5afaf3437f8b9ad2208fe843/html5/thumbnails/2.jpg)
The Debbie Burchett Endowment Fund
The Debbie Burchett Endowment Fund is a permanent endowment that was created in the Spring of 2000 benefiting Cancer Services, Inc.to assist women undergoing cancer treatment. The fund was named in honor of Debbie Burchett for her inspiration and service to survivors in the Winston-Salem area with breast cancer.
The purpose of the fund is to provide financial support to survivors without adequate means to cover ancillary costs related to cancer treatment. These needs include prosthetic products, transportation, child care, home care and other related expenses, not normally reimbursed by medical insurance, or other private funds.
Through Cancer Services, Inc. eligible recipients are identified and grants are provided from the fund for distribution to those with essential needs.
Cancer Services, Inc. is a local non-profit organization serving Davie, Forsyth, Stokes, Surry and Yadkin counties, providing without charge, a full range of services for those living with cancer. Our services include:
Patient Advocacy and Information Medication & Financial Assistance Equipment, Supplies, Wigs, & Prosthesis Transportation to Treatment Peer Support for Survivors Survive & Thrive Wellness Groups &
Programs Healing Hands Clinics Lifestyle Programs for Risk-Reduction &
Survivorship
For additional information about Cancer Services check our website at:
www.cancerservicesonline.org Benefiting
Cancer Services, Inc.Debbie Burchett Endowment Fund
Clemmons, NC June 6, 2015