Saturday, August 20, 2011 -- Uniontown, PA
Main Street Classic 5K Run/Walk ENTRY FORM
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RACE CONTACT: Vicki Yauger, Phone: 724-439-0201, E-mail: vyauger@citymissionfayette.org
FEE 5K Run/Walk = $20 by August 13 or $25 starting August 14, Kiddie Race = $5 through August 20
Mail to: City Mission- Living Stones, Inc., 155 North Gallatin Avenue, Uniontown, PA 15401
Name _________________________________________________________________
Date of birth _____________ Age as of 8/20/11_______ Sex: Male____ or Female____
Address ______________________________________________________________
Phone Number (______________)__________________________________
E-mail Address: ________________________________________________
Circle One: 5K Runner or 5K Walker
Shirt Size: (check one) S___ M___ L___ XL___ XXL___ XXXL___
(Please add an additional $3 to entry fee for XXL & XXXL sizes)
KIDDIE RACE Participant-(shirts not available to KIDDIE RACE participants.)
WAIVER: In consideration of the acceptance of this entry, I waive for myself, my heirs and assigns, any and all claims for damages which I may have against this race, its sponsors, or any organization, business or individual as a result of any and all injuries which may be received during this contest. Permission is granted to release any photos that include me.
Signature _________________________________________________ Date _________________
* Parent or Legal Guardian signature, if entrant is under age 18
* __________________________________________________________
** Please note, if you are pre-registered and not in attendance on race day, you must make arrangements with City Mission staff in order to obtain your race shirt. Race shirts will be guaranteed for one week after the event. **