Thursday, June 12, 2008 -- Connellsville, PA
Francis "Bud" Murphy Memorial 5K
Presented by the Highlands Hospital
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ENTRY FROM (Please Print) RACE NO.________ (Offical use only!) NAME___________________________________________________ ADDRESS________________________________________________ CITY________________________STATE_______ZIP____________ PHONE__________________________________________________ AGE ON RACE DAY_________________BIRTHDATE______________ MALE___ FEMALE___ RACE SELECTION: 5K RUN___ 5K WALK____ SHIRT ZIZE (Please circle one): S M L XL 2XL YouthWAIVER: 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.
* Results will be posted after the race.
Entry Fee: $15.00 Pre-Registered, $17.00 on Race Day
Please make checks payable to: Highlands Hospital
Mail entry forms to:
Highlands Hospital
401 East Murphy Avenue
Connellsville, PA 15425