Saturday, October 15, 2011 -- Shinnston, WV
Cougar Pride 5K Walk/Run ENTRY FORM
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Race Contact: Kim Howell (phone) 304-669-0277 (e-mail) gimmom99@aol.com
Cost is $15. Make checks payable to: Lincoln High School and mail to:
Kim Howell (Cougar Pride 5K ), 43 Main Street, Shinnston, WV 26431
Name:_____________________________________________________________________
Address:__________________________________________________________________
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Telephone: (____________________) __________________________________
Email:______________________________________________________________
Age As Of Race Date (10/15/11):___________ // Male____ or Female____
Release Statement:
In consideration of acceptance of this entry, I waive any and all claims for damages which may result from my participation, or the minor that I am signing for in the Cougar Pride 5K. Any and all claims are waived for myself, heirs, and assigns.
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Signature of Runner (Parent/Guardian must sign if under 18)
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Date