Saturday, August 21, 2010 -- Uniontown, PA / Storey Square
Main Street Classic 5K Run/Walk ENTRY FORM
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CONTACT: Vicki Yauger, Phone: 724-439-0201, E-mail: vyauger@citymissionfayette.org
Checks or money orders payable to: City Mission-Living Stones, Inc.
Mail to:
City Mission- Living Stones Inc.
155 North Gallatin Ave.
Uniontown, PA 15401
Name _____________________________________________________________________
Date of birth _______/_______/_________ Age as of 8/21/10_______ Sex _____________
Address ___________________________________________________________________
___________________________________________________________________________
Phone Number (____________)_______________________
E-mail Address: __________________________________________________________
Circle One: Runner Walker
Shirt Size: S____ M____ L____ XL____ XXL____ XXXL____
(Please add an additional $3 to entry fee for XXL & XXXL sizes)
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
___________________________________________________________________________
SIGNATURE OF Parent\ 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. **