Thursday, November 22, 2012 -- Shinnston, WV
Shinnston's Turkey Trot 5K / Gobble Wobble ENTRY FORM
Return to the Details Page
RACE CONTACT: Stacia Talkington (e-mail) stalkington@comcast.net
** EACH Participant must fill out a form (includes the Kids Run) ** Check only what applies. Fees are per participant.
**You must register by Oct. 20, 2012 to get a performance T-shirt (adults and kids).**
Make checks payable to "The Marie Gaston Scholarship Fund" and mail to:
Stacia Talkington
461 Lake Meade Drive
East Berlin PA 17316
Attn: Marie Gaston Scholarship Fund
Name ____________________________________________________________________
Address _________________________________________________________________
city/state/zip____________________________________________________________
Phone (____________________)______________________________________________
Email_____________________________________________________________________
Age on 11-22-12 ____________ Date of Birth ______/________/___________
Gender: ____Male or _____Female
Please Check One:
_____ Turkey Trot 5K Entry Fee = $15.00
_____ Gobble Wobble Fee = $10.00 (Children's Fun Run Ages 12&Under)
-
ADULT Shirt Size (check one): ___XS (women only) ___S ___M ___L ___XL ___XXL
YOUTH Shirt Size (check one): ___YS ___YM ___YL
In consideration of this entry, being accepted, I hereby for myself, heirs, executers, and administrators waive and release any claims that I may have against the City of Shinnston, West Fork Rail Trail, Marie Gaston Scholarship Fund or any of the sponsors involved in Shinnston's Turkey Trot 5K Walk/Run. I certify that I am physically able to participate in this event.
Signature_________________________________________________________________
Date_____________________________________
** ALL participants MUST SIGN, Parent/Guardian signs if participant is under 18 years of age **