Monday, September 7, 2009 -- Mount Pleasant, PA / Greenlick Run Lake,
Compete for the Cure Labor Day 5K Run/Walk
ENTRY FORM
PLEASE PRINT OUT APPLICATION, ENCLOSE CHECK AND MAIL TO:
Make check payable to: "COMPETE FOR THE CURE"
Mail to: Compete for the Cure c/o Kim Eicher, 620 N. Geary Street, Mount Pleasant, PA 15666
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NAME: ______________________________________________________________________
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ADDRESS: ____________________________________________________________________
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CITY:______________________________________ STATE:_________ ZIP:_____________
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PHONE:(_________)______________ AGE on 9/7/09:_________ SEX: ________
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Date of Birth:___________ choose one / RUNNER: _____ OR WALKER: ______
SHIRT SIZE: S | M | L | XL | XXL .... (Please Circle One)
**In consideration of the acceptance of this entry, I waive, for myself, my heirs, and assigns any/all claims for damages which may arise against all organizations and individuals connected with this race, as a result of any injuries which may be incurred during or from the race.
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APPLICANT SIGNATURE
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SIGNATURE OF PARENT (IF UNDER 18)