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Saturday, August 25, 2007 -- Uniontown, PA
National City© Main Street Classic
2007 Run for the Homeless (iPO Event Id#: 10073)

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Send completed applications to: City Mission- Living Stones, Inc. 155 North Gallatin Avenue, Uniontown, PA 15401

I am signing up for:             Standard Reg.          Late Reg.

______5K Run/Walk as a Runner    Pre-Reg. $15           Late Reg. $18

______5K Run/Walk as a Walker    Pre-Reg. $15           Late Reg. $18  





Phone / Email______________________________________________________

_________________    _______________
Age as of 8/25/2007         Gender

Adult Shirt Sizes:  M  L  XL  XXL            Child's Shirt Size:  S  M  L
In consideration of the acceptance of this application and intending to be legally bound, I hereby waive, discharge, and release myself and my heirs, successors, administrators, and executors, of any and all claims, damages, and causes of action of what so ever kind including negligence, that I may have as a challenge. Children, and all their respective heirs, successors, administrators, executors, asides, trustees, and parent subsidiaries or affiliated companies, if any. In addition, as an inducement for the acceptance of this application, I hereby certify that I have adequately trained for this event and am fully aware of the risks posed by motor vehicle traffic on the course. I further certify that I have read and have full understanding of its contents.

Signature              Date

Signature of Parent/Guardian (if under 18)           Date