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Saturday, September 17, 2011 -- Scottdale, PA
Scottdale Fall Festival 10K Run, 5K Run & Walk (iPO Event Id#: 13490)

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CONTACT: Charlie Ellis (phone) 724-887-7899

Fee $20 before September 16, $22 thereafter and day of race // Make check to Scottdale Fall Festival

Mail to Scottdale Fall Festival, 226 Pittsburgh Street, Scottdale, PA 15863

NAME:__________________________________________________________      ____MALE
                                                 
ADDRESS:_______________________________________________________      ____FEMALE
                                          
        _______________________________________________________      ____AGE 
                                                                    (on race day)
        _______________________________________________________

PHONE:  _______________________________________________________

Event: 10K___  5K Run___ 5K Walk___ // Shirt Size:  ___MED ___LG ___XLG     
In consideration of your acceptance of my application for entrance in the Scottdale Fall Festival 10K Run / 5K Run / 5K Walk, I for myself and anyone entitled to act on my behalf, waive and release the Scottdale Fall Festival, all sponsors, their representatives, and successors from all claims or liabilities of any kind arising out of my participation in this event.

Signature of Entrant:___________________________________________________

(REQUIRED) parent or guardian signature required for those under 18