Saturday, June 16, 2012 -- Farmington, PA
Fayette Veterans Advocacy Association 5K at Laurel Caverns
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RACE CONTACT: (e-mail) JOHN LAVERY: jllavery@rocketmail.com (724-557-3630) OR
LARRY STAVISH: my85thpa@verizon.net (724-245-9746)
ENTRY FEE . . . $15.00 pre-registration and $17.00 on RACE DAY
MAIL TO . . . FVAA c/o Larry Stavish, PO Box 8, New Salem, PA 15458
PAYABLE TO . . . FVAA
NAME____________________________________________________________________
ADDRESS_________________________________________________________________
CITY_________________________________________STATE_______ZIP____________
PHONE (_________________)________________________________
E-MAIL __________________________________________________
AGE ON RACE DAY_________________ BIRTHDATE_______/_______/______________
MALE___ or FEMALE___ RACE SELECTION: 5K RUN___ 5K WALK____
SHIRT SIZE (Please check one): S__ M__ L__ XL__ 2XL__ 3XL__ WAIVER: In signing this entry, I hereby release FVAA and Laurel Caverns from any claims or responsibility for any injuries suffered by me in this event. event.
_________________________________________________________________________ SIGNATURE (If under 18, Parent or Guardian MUST sign)
___ I do not plan on attending. However please accept my donation to the FVAA.
*Entry not valid unless all information herewith is filled out and signed.
T-SHIRT GUARANTEED ONLY ON PRE-REGISTRATION – NOT RACE DAY