Saturday, April 5, 2014 -- Philippi, WV / United States
Spring Fever 5K
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RACE CONTACT:Bonnie Burich (email) burichbj@battlers.ab.edu
Fee: $15.00 pre-registration by March 21 and $20.00 on RACE DAY
MAKE CHECKS PAYABLE TO: Hu C. Myers Society
MAIL TO:
PA Program Office
101 University Hill Drive
Box 2003
Philippi, WV 26416
Name: _____________________________________________________________________________
Address: __________________________________________________________________________
___________________________________________________________________________________
Phone: (________________)___________________________________________
Email_________________
Date of Birth ____/____/__________ Age on 4/05/14: _______ Gender: ____Male or ____Female
Adult Sizes: ____S/____M/ ____L/ ____XL/ 2XL___ 3XL____
RACE SELECTION: 5K RUN ____ 5K WALK ____
Emergency Contact____________________________________________________________________(Required) (Name and Relation)
Emergency Contact Phone: _____________________________________
WAIVER: In signing this entry, I hereby release Alderson Broaddus University, The Hu C. Myers Society, and MedExpress from any claims or responsibility for any injuries suffered by me in this event.
I have read and understand the contents and the consequences stated in this notification.
___________________________________________________________________________________
Signature
*(Parent/Guardian must sign if participant is under 18 years of age.)
__ I do not plan on attending race day. However, please accept my donation to the Hu C. Myers Society.
* Entry not valid unless all information herewith is filled out and signed.