5th Annual Adelphoi Village Founder's Day 5K Run

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Saturday, August 12, 2000 -- Latrobe, PA
5th Annual Adelphoi Village Founder's Day 5K Run

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Mail completed registration form with your check to:
AV Founders Day 5-K Run/Walk
Main Street
Latrobe, PA 15650

Make check payable to: Adelphoi Village

Name_________________________________________

Address______________________________________

City_________________ State____ ZIP__________

Phone________________________________________

Age_________  Gender:  M  F

Runner___  Walker___  Family___

if Family Division,
enter family name:___________________________


Shirt Size (adult)  S  M  L  XL

Please read and sign:
Waiver: I hereby waive and release any and all rights and claims for damages or injury I may have against the sponsors and officials of Adelphoi Village, for my participation in said event of August 12, 2000 for any and all injuries suffered to me. I also attest that I am physically fit and have trained sufficiently for the event.

________________________________________
Signature

________________________________________
Date

________________________________________
Guardian (if participant under 18 years)

Affiliates: WVMBA | MAGP | WVMTR | APRRS | WVCXS