Saturday, June 21, 2014 -- Uniontown, PA / Uniontown High School
Chef Joe's Omelet Run
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RACE CONTACT: Joe Everhart(email) ajeverhart@atlanticbb.net (Phone) Home phone 724 439-2113 or Cell phone 724 984-6795
Send registration form to:
Joe Everhart
13 Marion Street
Uniontown, PA 15401
Pre-Registration Fee: $15.00
Post-Registration Fee: $25.00
First name:______________________________________ M.I.: ____
Last name:__________________________________________________
Date of Birth:_____/______/______ Age on Race Day_____
Address:____________________________________________________
State_________ Zip_____________
Sex M or F
Check one: 5K Run _____ 5K Walk _____ Little Scramble ____________
Child T-Shirt Size (Check One): Small___ / Med____ / Large____
Adult T-shirt Size (Check ONE): Small___ / Med___ / LG___ / XL___
Waiver of Liability:
Being that I am physically fit and have trained for this race, I waive any and all rights and claims for damages I may have. I relieve sponsors, directors, and all peoples and groups associated with this race of any and all liabilities.
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SIGNATURE
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Date
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SIGNATURE (Parent's signature if under 18 years old)
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