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Saturday, August 22, 2009 -- Uniontown, PA / Storey Square
Main Street Classic 5K Run/Walk for the Homeless ENTRY FORM (iPO Event Id#: 11283) -- Return to the Details Page

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.

$20 by August 14, $25 starting August 15

Please make checks or money orders payable to ... City Mission-Living Stones, Inc.

Send completed applications to: City Mission- Living Stones, Inc. 155 North Gallatin Ave., Uniontown, PA 15401

Name_____________________________________________________________

Address___________________________________________________________

___________________________________________________________________

City/State/Zip_____________________________________________________

Age as of 8/22/2009 ___________________ // ____Male or ____Female

Circle One: Runner Walker

Shirt Size: S__ M__ L__ XL__ *XXL__ *XXXL__

(*Please add an additional $3 to entry fee for XXL & XXXL sizes)

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/Guardian (if under 18)

_______________________________________
Date

MAKE COPIES AS NEEDED.