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Runner:

Walker:                

                     Registration Form

      (certified course & professional timer)

                                                                                              Sunday, October 11th, 2009

              11:30 a.m.

               “Walkers Welcome: Start time 10:30 a.m.”

Location:Bank of America Parking Lot, Pascoag, RI

For further information:401-568-9470 and www.burrillville.org

Registration:Pre-entries:$18.00 On line at www.needtorace.com

Mail in by October 8, 2009$18.00

Race Day entry$20.00

Mail to:Burrillville Parks & Rec.

92 North Main Street

Pascoag, RI  02859

Directions: Route 295 to Route 44 Smithfield exit. Follow through Chepachet and take right at intersection

with Route100 and Route 102.  Follow Route 100 until 1st stop sign. Bank of America parking lot on right.

         “Cash Awards for Runners”

Prizes:        Cash prizes to top (3) finishers overall for both Men & Women

1st place -              $200.00

2nd place -  $100.00

3rd place -              $  75.00  

Course record breaker:  $200.00  (To be split if both men’s and women’s records are set)

   Course records:  Keith Kelly – 14:23 (2003) and Stephanie O’Reilly – 16:49 (2003)

Trophies:  to the winner in each category (19 and under, 20-29, 30-39, 40-49, 50-59, 60-69 & 70 &over)

On line registration available: www.needtorace.com

Additional entry forms, maps, and on line registration available at http://www.geocities.com/oplusfinish/

***T-shirts to first 100 runners to register***

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                                   “Burrillville 2009 “Snakes Alive”

      Please Print All Information Required, Sign & Mail With Check By Oct.  8th, 2009.  You May Also Register on Race Day.

                Mail $18 check and entry to Burrillville Parks &Rec., 92 North Main Street, Pascoag, RI  02859

Name Age Sex

Mailing Address _____________________________City Phone

State ________ Zip  E-mail

Waiver:

I will participate in a 5K Burrillville 2009 Snakes Alive Road Race to benefit ongoing community related projects.  Event sponsored by the Burrillville

Parks and Recreation Department.   I assume, recognize and accept full responsibility and release the Town of Burrillville, its affiliates, their event

organizers, and officials from any liability thereof.

Participant’s Signature______________________________________________   Date           (parent or guardian must sign if under the age of eighteen)

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