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Thursday, November 22, 2012 -- Shinnston, WV
Shinnston's Turkey Trot 5K / Gobble Wobble ENTRY FORM (iPO Event Id#: 14149)

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RACE CONTACT: Stacia Talkington (e-mail)

** EACH Participant must fill out a form (includes the Kids Run) ** Check only what applies. Fees are per participant.

**You must register by Oct. 20, 2012 to get a performance T-shirt (adults and kids).**

Make checks payable to "The Marie Gaston Scholarship Fund" and mail to:

Stacia Talkington
461 Lake Meade Drive
East Berlin PA 17316
Attn: Marie Gaston Scholarship Fund

Name ____________________________________________________________________

Address _________________________________________________________________


Phone (____________________)______________________________________________


Age on 11-22-12 ____________ Date of Birth ______/________/___________

Gender: ____Male or _____Female

Please Check One:

_____ Turkey Trot 5K Entry Fee = $15.00

_____ Gobble Wobble Fee = $10.00 (Children's Fun Run Ages 12&Under)

    ADULT Shirt Size (check one): ___XS (women only) ___S ___M ___L ___XL ___XXL Women's shirts will be fitted

    YOUTH Shirt Size (check one): ___YS ___YM ___YL

In consideration of this entry, being accepted, I hereby for myself, heirs, executers, and administrators waive and release any claims that I may have against the City of Shinnston, West Fork Rail Trail, Marie Gaston Scholarship Fund or any of the sponsors involved in Shinnston's Turkey Trot 5K Walk/Run. I certify that I am physically able to participate in this event.



** ALL participants MUST SIGN, Parent/Guardian signs if participant is under 18 years of age **