Saturday, August 23, 2008 -- Uniontown, PA
Main Street Classic 5K Run/Walk for the Homeless
ENTRY FORM
Send completed applications to: City Mission- Living Stones, Inc. 155 North Gallatin Avenue, Uniontown, PA 15401
REGISTER EARLY AND SAVE!
I am signing up for: Standard Reg. Late Reg. ______5K Run/Walk as a Runner Pre-Reg. $15 Late Reg. $18 ______5K Run/Walk as a Walker Pre-Reg. $15 Late Reg. $18
Name_____________________________________________________________
Address___________________________________________________________
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City/State/Zip_____________________________________________________
Phone / Email______________________________________________________
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Age as of 8/23/2008 ___________________ // ____Male or ____Female
Adult Shirt Sizes: M L XL XXL // Child's Shirt Size: S M L
In consideration of the acceptance of this application and intending to be legally bound, I hereby waive, discharge, and release myself and my heirs, successors, administrators, and executors, of any and all claims, damages, and causes of action of what so ever kind including negligence, that I may have as a challenge. Children, and all their respective heirs, successors, administrators, executors, asides, trustees, and parent subsidiaries or affiliated companies, if any. In addition, as an inducement for the acceptance of this application, I hereby certify that I have adequately trained for this event and am fully aware of the risks posed by motor vehicle traffic on the course. I further certify that I have read and have full understanding of its contents.
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Signature ------------------------------------------------ Date
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Signature of Parent/Guardian (if under 18)---------------- Date
MAKE COPIES AS NEEDED.