Sunday, October 6, 2013 -- Morgantown, WV / Marilla Park Center, Deckers Creek Trail
Kick It 2 Cancer 5K Run/Walk & Family Fun Day
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RACE CONTACT: (e-mail) Tina Bland: tina.m.bland@gmail.com (304-276-7399) Or (e-mail) Missy Moury: mmoury429@gmail.com (304-698-7328)
ENTRY FEE . . . $20.00 pre-registration by 09/6/2013 and $25.00 After and on Race Day.Fees are nonrefundable.
MAIL TO . . .
Tina Bland
603 Schubert Place
Morgantown, WV 26505
PAYABLE TO . . . Susan G. Komen 3 Day
NAME____________________________________________________________________
ADDRESS_________________________________________________________________
CITY_________________________________________STATE_______ZIP____________
PHONE (_________________)________________________________
E-MAIL __________________________________________________
AGE ON RACE DAY_________________ BIRTHDATE_______/_______/______________
MALE___ or FEMALE___ RACE SELECTION: RUN___ WALK____
SHIRT SIZE (Please check one): S___ M___ L___ XL___ XXL___ XXXL___
WAIVER:
In consideration of your acceptance of my application for entrance in the Kick it 2 Cancer 5K Run/Walk, I, for myself and anyone entitled to act on my behalf, waive and release Team 2CEMGROW and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. I also release any photos that may involve myself. FONT>
The Kick It 2 Cancer 5K Run/Walk and Family Fun Day is not part of the Susan G. Komen Foundation or its affiliate groups. This event is being held by Team 2CEMGROW to raise the funds required for participation in the Susan G. Komen 3 Day in Atlanta, GA October 18 to 20, 2013.
To join Team 2CEMGROW or for more information, please refer to: [www.the3day.org].
Additional Childrens T-shirt Form
$10 with Paying Adult Registration
Registered Adult Name:___________________________
Child Name:_______________________________
SHIRT SIZE (Please check one): S___ M___ L___ XL___ XXL___ XXXL___
Youth Size: S___ M___ L___
Number of Children T-shirts _______ x $10 = Total______
_________________________________________________________________________
SIGNATURE (If under 18, Parent or Guardian MUST sign)