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Sunday, April 17, 2005 -- Hopwood, PA
Mount Summit Challenge
(iPO Event Id#: 6713)
Return to the Details Page
Mail to: Fayette Striders Running Club, P.O. Box 1441, Uniontown, PA 15401
Pre-registration Deadline: Postmark by April 10, 2005 - $17 ($22 thereafter)
Checks payable: Fayette Striders Running Club
Please PRINT CLEARLY
Name________________________________ Age____ Date of Birth________
Address___________________________________________________________
City_________________________________ State______ Zip_____________
Phone_________________________ Sex: Female Male
PLEASE CIRCLE ONE
EVENT: WALKER RUNNER
PLEASE CIRCLE ONE
IF RUNNER, What Division? Open/Age Group CRUISER CLYDESDALE
Shirt size (circle one) S M L XL XXL(+$2.00)
In consideration of my entry being accepted in the Mt. Summit Challenge race, I, intending to be legally bound, do hereby, for myself, my heirs, executors, and assigns, waiver, release and forever discharge any and all rights and claims for damages that I may have or which may hereafter accrue to me against the Mt. Summit Challenge, Fayette Striders Running Club, SERJ Racing Services,
PennDOT, and all sponsors.
__________________________________________________________________
Athlete Signature Date
__________________________________________________________________
Signature of Parent/ Guardian if Athlete is under 18 yrs of age
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