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Wednesday, July 9, 2008 -- Connellsville, PA
26th Annual John Woodruff 5K ENTRY FORM (iPO Event Id#: 10892)

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Fees: High school track team members $10.00 with coach signature.
$15.00 is mailed by July 5, $18.00 thereafter and on race day

Checks payable to John Woodruff Club.

Mail to: John Woodruff Club, 706 Blackstone Avenue, Connellsville, PA 15425

please print)

NAME: _______________________________________________________________________

ADDRESS: ____________________________________________________________________

CITY: __________________________________ STATE: _______ ZIP: ________________

AGE (on race day): _______ // DATE OF BIRTH: _______________

PHONE: (______________)_____________________________________

Circle One: MALE // FEMALE -------- T-SHIRT SIZE: S M L XL


Waiver: In signing this entry, I hereby release The John Woodruff 5K Race and Walk from any claims or responsibility for any injuries suffered by me in this event.

Signature: _______________________________________________________________

(** If under 18, parent or guardian must sign.)

Entry not valid unless all information herewithin is filled out and signed.