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Saturday, June 17, 2000 -- Connellsville, PA
Francis Bud Murphy Memorial 5K
Presented by the Highlands Hospital

Please make checks payable to: Highlands Hospital

Mail entry forms to:
Highlands Hospital
401 East Murphy Avenue
Connellsville, PA 15425

[Race Details Page]


(Please Print)
NAME___________________________________________________
 
ADDRESS________________________________________________

CITY________________________STATE_______ZIP____________

PHONE__________________________________________________

AGE ON RACE DAY_________________BIRTHDATE______________

MALE___ FEMALE___ RACE SELECTION: 5K RUN___ 5K WALK____

SHIRT ZIZE (Please circle one):   M    L    XL
WAIVER: In signing this entry, I hereby release Highlands Hospital from any claims or responsibility for any injuries suffered by me in this event.
_______________________________________________________
SIGNATURE  (If under 18, Parent or Guardian MUST sign)

* Entry not valid unless all information herewith is filled out and signed.

* Resutls will be posted after the race.