Saturday, November 27, 2010 -- Green Bank, WV / National Radio Astronomy Observatory
Green Bank Turkey Trot 5K ENTRY FORM
CONTACT: Mike Stennes (phone) 304-456-2132, (e-mail) mstennes@yahoo.com
$10.00 in advance, $15.00 on race day ** Mail form/fee by NOV. 9, 2010 to get a shirt! **
Mail to:
Mike Stennes/Green Bank 5K
PO Box 2
Green Bank, WV 24944
Please Print.
NAME_______________________________________________________________________
FEMALE _____ MALE______ // AGE (as of 11/27/10)_________
ADDRESS____________________________________________________________________
____________________________________________________________________________
T-SHIRT SIZE (Check One)
ADULT: S___ M___ L___ XL___ XXL___
CHILD: S___ M___ L___ XL___
RELEASE AND WAIVER: I assume all risk involved in this event. I hereby, for myself, son/daughter, waive and release all rights and claims for damages or injuries against NRAO, Pocahontas Board of Education, volunteers, and officials associated with this event. Participants under the age of 18 must have parent/guardian sign form.
Signature:
NAME_______________________________________________________________
DATE_____________________________