Saturday, March 17, 2001 -- Grandview Heights, OH
Meijer St. Patricks Day 5K
Runner or Walker Entry Form

Entry Fees:

• $20.00 early registration (until March 9th)
• $25.00 day of event registration
• Note - First 500 participants receive a T-Shirt

Send form with check or credit card informtaion to:
NFK of Ohio
1373 Granview Ave., Suite 200
Columbus, Ohio 43212-2804

Or Charge by phone at: (614) 481-4030 ext. 226

Return to the Meijer St. Patrick's Day 5K [Details Page]

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YOUR NAME

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ADDRESS

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CITY/STATE/ZIP

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DAYTIME TELEPHONE

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CAPTAIN'S NAME (if you're on a Team)

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EMPLOYER

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DIALYSIS CENTER

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TRANSPLANT CENTER

Disclaimer: In consideration of acceptance of this entry, I hereby waive and release all any and all rights and claims for damages which I may have against any municipalities, person(s), sponsor(s), or corporation(s) associated with the National Kidney Foundation of Ohio, Inc., and assigns for any and all injuries which I may suffer while taking part in the 5K Run/Walk or as a result thereof.

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SIGNATURE OF RUNNER OR WALKER

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SIGNATURE OF PARENT/GUARDIAN IF UNDER 18 YEARS OF AGE