Galesburg Days 5K/1M Cemetery Run/Walk Registration
If you would like to register online, you may do so by filling out the questions below. You then have three options. You may mail me a check for your entry fee, you may pay the day of the race, or pay using PayPal. I realize there is a certain amount of risk for me allowing you to pay the day of the race but I am going to trust that if you choose that option, then you will show up for the race. If you would like to use PayPal you will have three options at the end of the registration to choose from. One, you are not wanting a shirt. Two, you do want a shirt. Three, if you are wanting pay for multiple entries or for a shirt size bigger than XL. If using the third option you will have to enter the money amount yourself. I am also going to send an email with the PayPal option on it as well.

If you would like to receive a PDF or Word format of the following information, email me and I will send you one individually.

Galesburg Days 5K/1 Mile Run/Walk
25th Annual

Participants must choose either the 5K or 1 mile distance in which to participate.

DATE: Saturday, September 15th, 2018

TIME: Run/Walk—7:15 AM
Registration—6:45 AM

PLACE: The Store (Across from Tank Connection)

ENTRY FEE: Pre-Registration received by 9/11/18
$13.00 (includes T-shirt)
$8.00 (does not include T-shirt)
Registration received after 9/11/18 or Day of Race
$15.00 (includes T-shirt as they are available)
$10.00 (does not include T-shirt)

AGE GROUPS: 9 and under, 10-14, 15-19, 20-29, 30-39, 40-49, 50-59, 60 and up

AWARDS: The following will be awarded per distance:
Medals to top 3 finishers in each age group for men and women
Plaque to first place overall for men and women

Please clip and mail to: Nate Clevenger, 485 S 190th, Pittsburg, KS 66762
Phone:(660)651-8826 Or email the following information to

Name: _____________________________ Age: _______ Sex: _____

Street Address: _________________________________________

City: _______________________ State: _______ Zip: ____________

Distance of Choice: 5K 1 Mile Email: ___________________

Adult Shirt Size (if receiving one): S M L XL XXL XXXL (add $2 for XXL or XXXL)
Youth Shirt Size (if receiving one): S M L

Fee Enclosed $__________ (Make checks payable to: Nate Clevenger)

In consideration for your acceptance of this entry, I hereby, for myself and my heirs, waive all rights and claims for damages I may have against the City of Galesburg, Galesburg Days Committee, race personnel or volunteers with this event, for any injuries suffered by me in connection with said event. I understand I must be in good health to participate. I also give permission for the free use of my name and pictures in any media account of this event.

Signature: ___________________________________

Parent or Guardian (if under 18): _______________________________

Last Name: *
Your answer
First Name: *
Your answer
Age *
Your answer
Sex: *
Address: *
Your answer
City: *
Your answer
State: *
Your answer
Distance of Race: *
Your answer
Shirt Size: *
Add $2 for XX-Large and Up
Payment Option: *
Link To Pay By Paypal For Pre-Registration NO SHIRT $8
Your answer
Link To PayPal For Pre-Registration 1 SHIRT $13
Your answer
Link To PayPal For Pre-Registration Of Multiple Registrations You will need to enter the amount you owe when you get to PayPal
Your answer
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