Saturday, July 9, 2011 -- Buckhannon, WV
Band of Brothers Kicking Cancer 5K Run/Walk
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Race Contact: Andrew Shay (phone) 304-472-0789 (e-mail) BoB-KickingCancer5K@hotmail.com
Entry Fee: $20 before 6/30/11 and $25 thereafter and on race day
Address to send entry to:
Band of Brothers, 88 South Kanawha Street, Buckhannon, WV 26201
Name___________________________________________________________________
Address________________________________________________________________
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Phone (________________)_________________________________________
E-Mail___________________________________________________________
Male ___ or Female ___ // Run___ or Walk___ // Date of Birth___________
Age on 7/9/11_____________ // T-Shirt Size: M___L___XL___
How did you hear about this event?________
In consideration of your acceptance of my application for entrance in the Band of Brothers Kicking Cancer 5K, I for myself and anyone entitled to act on my behalf, waive and release Chapel Hill United Methodist Church and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out my participation in this event. The participant represents and warrants that he/she is in good physical condition and is able to safely participate in the race. Participant is aware of the risks and hazards involved with 5k run/walks. You MUST Sign.
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Signature
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Date
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Signature of Parent /Guardian, if under 18
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Date