 Signature (or signature of parent or guardian if runner is under 18) and Date |
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Name |
|
Address |
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City, State and Zip Code |
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_ E-Mail Address |
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FOURTEENTH ANNUAL KIMBERTON RUN SEPTEMBER 29, 2012 |
Please print and enclose the following Registration Form and check payable to the
Kimberton Lions Club and mail to:
Bob Toff
1259 W. Evergreen Drive, Phoenixville, PA 19460
For
further information call:
610-935-2346
(To register on-line,
please click here.)
| REGISTRATION FORM AND WAIVER n consideration of
this entry being accepted. I, intending to be legally bound, hereby for
myself, my heirs, executors, and administrators, waive and release any and
all rights I may have against East Pikeland Township, sponsors,
representatives, successors, and assigns for any and all injuries
(including death) suffered by me at said race. I attest and verify that I
have full knowledge of the risks involved in this event, and am physically
fit and sufficiently trained to participate in this event. Further, I
hereby grant full permission to any and all of the foregoing to use
photographs, videotapes and other records of this event for any purpose
whatsoever. |
|
Approved strollers only
! For safety reasons, please leave pets at home. In support of PACS, the Phoenixville Area Community Services Organization, we will again be collecting cans of food at the race for those less fortunate. |
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Signature (or signature of parent or guardian if runner is under 18) and Date |
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Name |
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Address |
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City, State and Zip Code |
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_ E-Mail Address |
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Age:
_____ Female (
) Male (
) |
Prepay entry up to September 21st. 5K Run/Walk - $15 includes T-shirt Kid’s Fun Run (children under 12) - $7 includes T-shirt |
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| *Check T-Shirt Size: | Check Designated Event: | |
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( ) S (Kids Only) ( ) M ( ) L ( ) XL |
( ) 5K Run ( ) Clydesdale/Lioness ( ) 5K Walk ( ) Kid's Fun Run |
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Thank you for your kind consideration. |
||