Saturday, October 1st, 2011

10:00am

Wakanda Park

Menomonie, WI

5K Run/Walk

BENEFITING THE

GET YOUR MOJO ON!

PLEASE READ & SIGN FOR PARTICIPATION

I know that running or walking a road race is a

potentially hazardous activity. I should not enter and run/walk unless I am medically able and

properly trained. I agree to abide by a decision of a race official relative to my ability to safely com-plete the run. I assume all risks associated with running this event, including but not limited to: falls, contact with other participants, effects of

weather, including cold, high heat or humidity, traffic and conditions of the road; all such risks

being known and appreciated by me. Having read this waiver and knowing these facts and in

consideration of your accepting my entry, I for myself and anyone entitled to act in my behalf,

waive and release all race officials and agents; the City of Menomonie; and all sponsors, their

representatives and successors from all claims or liabilities of any kind arising out of my

participation in this event though that liability may arise out of

negligence or carelessness on the part of persons named and not named in this waiver. I certify I am an amateur and eligible to participate in this

competition. I permit the organizers to use photo-graphic images taken during the event for

promotional purposes.

Signature

_________________________________

Guardian_____________________

(If under 18 years of age, authorized

signature of guardian needed)

Date

ABOUT MARTY

Raised in Menomonie,

WI, Marty Miller was

truly unique. His frank

candidness, clever wit

and sly smile allowed

many doors to open

and many friendships

to come his way easily.

He was an MHS Class

of „91 Grad, attended

UW-Stout and worked within the community. In

May, 2009 at the age of 36, Marty, his wife An-

drea and their two sons learned of his diagnosis

of Acute Myeloid Leukemia (AML). Marty bat-

tled through multiple rounds of chemo, a stem

cell transplant and many blood transfusions. In

the height of his battle he never used the words

“give up”. He was always telling everyone to

“Keep the Faith” and “Live Life and Fight”. The

Doctor‟s anticipated Marty would not reach his

37th birthday in April , 2010. Marty had faith on

his side and prior to his diagnosis, he had been

running and had gotten into his best physical

shape in years. This proved to give him an addi-

tional four months with his family. A summer

with his sons, filled with great fun that will never

be forgotten. After 17 months and two failed re-

missions Marty lost his battle to this horrible dis-

ease in October 2010. He is truly missed every-

day. We dedicate this event to him, his fight and

the hope of helping others to overcome their bat-

tle with blood cancers.

On Saturday, October 1st, 2011,

Wakanda Park in Menomonie

will be the site of the

First Annual Marty's Mojo 5K

Run/Walk & Pig Roast.

The Mojo will benefit the

Leukemia & Lymphoma Society

of Wisconsin in honor of

Marty Miller.

Registration:

Register on-line at :

martysmojo.zapevent.com

OR by submitting the attached

form & payment to:

Marty’s MOJO

PO Box 434

Menomonie WI, 54751

Or Drop Off At:

Anytime Fitness

1700 Stout St. Menomonie, WI

Please make checks payable to:

Marty‟s MOJO

Visit Our Website:

www.martysmojo.com

NAME:

ADDRESS

CITY

STATE

ZIP

PHONE

EMAIL

AGE (on date of the race)

Please Circle:

Male Female

Shirt Size

Adult SM MED LG XL XXL

Child SM MED

CIRCLE YOUR EVENT

5K ONLY

5K & PIG ROAST

PIG ROAST ONLY

PLEASE SEE/SIGN

WAIVER ON BACK (OVER)

REGISTER TO GET YOUR MOJO ON! REGISTRATION FEES:

5K Event ONLY

$20-Before September 22, 2011

$25-After September 22, 2011

5K Event & Pig Roast

$27-Before September 22, 2011

$32-After September 22, 2011

Pig Roast ONLY

$7– PAPER REGISTRATION ONLY

Late Registration*

Friday, Sept. 30th 6pm-7pm

Anytime Fitness , 1700 Stout Street,

Menomonie, WI

OR

Saturday, October 1st , 8am-9:30am.

Wakanda Park

*Late day registration is accepted but

does not guarantee t-shirt/goodie bag.

Awards**

Awards will be given to the top 3 male

and female winners in all age groups.

Age groups are:

14 & Under, 15-19, 20-29, 30-39, 40-49,

50-59, 60+

**Race will be Chip Timed

Living Life & Fighting

For a Cure Against

Blood Cancers

Get Your MOJO On!

Saturday, Oct. 1st, 2011

10:00am - Wakanda Park

Menomonie, WI