"Cup Cake Challenge "
September 15th 2012
Thrid Annual 5K and 1K
Mountains Scenery and Country View
Pre-register Guarantees a T-shirt and Bib Number
Larry Duttweiler 770-983-7568 Clermont Town Hall 770-983-7568
Clermont Cupcake Challenge Application
Last Name: _____________________ First Name: ______________________ For Official Use Only:
Address: ________________________________________________________
City: ___________________ State: _______ Zip: ___________
Age: ______
Bib Number: ___________
Day Phone: _________________________ Gender (Circle One): M F
Email Address: ___________________________________________________
Shirt Size (Circle One): YS YM S M L XL XXL
WAIVER:
In consideration of the acceptance of my entry I hereby agree to comply with all rules and regulations for safety of myself and other partici-
pants. I also waive and release any and all rights and claim damages I have against Clermont Days, the City of Clermont, Hall County, and Concord Baptist Church, Runner’s Fit Race Works, sponsors, volunteers or any facility used for this event, for all injuries which may be suffered by me in connection with my competition in said event. I give my permission for the free use of my name(s) and/or photo in any medium of this event.
Signature (or parent if under 18): ___________________________________________ Date: ________________
Saturday, September 17th, 2011
Make checks payable to: Town of Clermont
Mail to: Clermont 5K Location: Concord Baptist Church Parking Lot
P.O. Box 257 640 Main St. Clermont, GA 30527
Clermont, GA 30527
Come join us for a great run on a safe, flat course, score a wear-able art T-shirt designed by
Action Awards, and enjoy a top-notch snack with one of the world’s very best cupcakes baked
locally by Truelove Celebrations!!! Then stay with us in the shadow of Wauka Mountain for
the Clermont Days Festival.
Registration: $10 for 1K, $15 for 5K per person if pre-registered by September 3, 2012. After Sep-
tember 3, $15 for 1K, $20 for 5K through race day. Registration begins at 7:00 AM in Concord Bap-
tist Church parking lot on Hwy. 254
Info: For more information contact Larry Duttweiler (404)-861-0688 or
Zack Loggins of Runner’s Fit Race Works at (770)-561-1050