Dr. William Perkins Memorial Events

The 29th Annual
Dr. William Perkins Memorial Events
Saturday, July 19, 2014
Wayne County Fairgrounds
Sponsored by
Wayne Memorial Health System, Inc.
Honesdale’s Friends of Track & Field and Cross Country
Wayne County Commissioners
5K Run
8:30 a.m.
Flat and Fast -Start and
finish at Wayne County
Fairgrounds, one mile north
of Honesdale, Rt. 191.
Individual Awards
(No duplications)
Male and Female
0-12 40-44
13-15 45-49
16-18 50-54
19-24 55-59
25-29 60-64
30-34 65-69
35-39 70+
1st Place Overall Male & Female Receive
5K Age Groups: Awards to 1st, 2nd, 3rd
1st Place Male and Female WMHS
Employee Receive Trophy.
*High School Challenge*
Sponsored by
Brian T. Kelly C.P.A.
RE/MAX Wayne
Pioneer Construction Co. Inc.
B & B Chrysler Dodge Jeep Ram
Cash Award Donated to High School Affiliated
Booster/Parent Clubs
$200 Top Men’s Race team (5 runners per team)
$200 Top Women’s Race team (5 runners per team)
$200 to the team with the most participants
5K Wayne Memorial Fitness Walk
8:30 a.m.
We welcome walkers of all ages.
Challenge yourself and the clock in this
noncompetitive event.
Separate Runs for Men
and Women (if needed)
Individual Awards
Male and Female
1st Place Male and Female Overall
Receive Awards.
1st Place in Each Age Group Receives
Quarter Mile Fun Run 9:45 a.m.
On the Fairgrounds Track.
Ribbons to finishers.
Return this section with Entry Fee by July 12, 2014 (PLEASE PRINT)
Make checks payable to: Friends
One Mile Run
9:30 a.m.
Two laps around track
Adult Shirt Size: XS S M L XLG (Circle One)
of Track & Field & Cross Country
Send to: Tammy Jensen, 315 Elizabeth St. Hawley, PA 18428
570-352-6100 email: [email protected]
Please check events you wish to enter below:
_____5K Run (3.1 miles) $18; (Post entry $20)
_____One Mile $10: (Post entry $12)
_____Quarter Mile (Free)
_____5K Fitness Walk $12 (Post entry $15)
Family Discount: Each member must use a separate form
of a family entered after the first three (3),
Pre-entry -- $5 each additional family member
Post-entry -- $8 each additional family member
Name________________________________________Sex_______Age (as of 7/19/14)____________________
In consideration of the acceptance of my entry, I, intending to be legally bound, do hereby waive, release and discharge any and all
claims which I may have or which may hereafter accrue against any and all sponsors while participating or while traveling to and from
the event.
Signature_______________________________________________(Signature of parent if runner is under 18)
High School Team___________________________________________Check if WMH Employee______