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Please print and mail to
Jerry Smith
po box 52 Delphos Ohio 45833
Race starts at 8:00 am May 8th
at the March Foundation VanWert Ohio
Rain or shine. fee is $ 15 before & race day
( $ 5 if a Vanwert cancer Survior )
NAME__________________________________
AGE ON RACE DAY _______________________
MALE / FEMALE
ADDRESS ______________________________
CITY / ZIP _______________________________
EMAIL__________________________________
PHONE # _______________________________
SHIRT SIZE _______________ ONLY IF PRE REG. BY APRIL 21
WAIVER; I AGREE TO HOLD ACS AND ITS DIRECTORS, OFFICERS, EMPLOYEES, VOLUNTEERS AND SPONCERS HARMLESS FROM and AGAINST ANY AND ALL SUITS, ACTIONS, DEMANDS, PROCEEDINGS,
LOSSES, COST AND EXSPENCES INCLUDING WITHOUT LIMITATIONS
ALL DAMAGES AND LIABILITIES IN ANY WAY ARISING OUT OF OR
RELATING TO OR CONNECTED WITH MY PARTICIPATION IN THE 5K.
_________________________________________________________
Participants signature & date ( parents signature if under 18 )
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