Monday, September 6, 2010 -- Mount Pleasant, PA / Greenlick Lake
Compete for the Cure Labor Day 5K
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Make check payable to and mail to:
"COMPETE FOR THE CURE" c/o Kim Eicher, 620 N. Geary Street, Mount Pleasant, PA 15666
NAME: _______________________________________________________________________ PHONE: (_________________) ________________________________ ADDRESS: ____________________________________________________________________ CITY: _____________________________________ STATE: _______ ZIP: ___________ AGE: _____ SEX: ______ BIRTHDATE: _____/______/___________ E-MAIL ADDRESS: ____________________________________________________________ 5K RUN _____ 5K WALK ______ 1-Mile Fun Walk ______ SHIRT SIZE: CHILD SM MED LG XLG XXLG (PLEASE ADD $2 FOR XXLG)
**In consideration of my entry being accepted in the Compete For The Cure 5K race/run/walk, intending to be legally bound, I waive, for myself, my heirs, executors and assigns any/all rights and claims for damages that I may have or which may hereafter accrue to me against the Compete For The Cure Race, and any/all individuals associated with this race. I understand the difficulty of this event and attest that I am in good physical condition. Permission is also granted to release any photos that include me.
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APPLICANT SIGNATURE
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SIGNATURE OF PARENT (IF UNDER 18)