Saturday, June 19, 2010 -- Madison, WV / Scott High Football Field
Bobby Hampton Memorial Race ENTRY FORM
Return to the Details Page
Please make checks payable to KaBoom and return form to:
Stephanie LaFauci
1027 Hill Valley Drive
Julian, WV 25529
PLEASE RESERVE
___ $250.00 Mile Marker Sponsorship
You will be contacted to obtain business logo and additional information. You must reply by 6/14 to have a mile marker printed.
___ $15.00 Early Bird Pre-Registration Fee (mail by 6/15 to receive a free T-shirt)
___$20.00 Registration Fee (after 6/15 and on race day)
___ Kids' Race (FREE)
Name_______________________________________________________________________
Address____________________________________________________________________
City/State/Zip_____________________________________________________________
E-mail Address ____________________________________________________________
Male/Female__________ // Age ___________
Phone_________________________________________________// Shirt Size________
Signature__________________________________________________________________
Date_______________________