registration form .pdf

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Original filename: registration form.pdf
Title: registration form
Author: Ellen Beckerman

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The 2nd Annual

Little Moe 5K Walk/Run
to benefit horse rescue at the CNY SPCA
organized by Skanda Equine, home of the Onondaga Rescue Ponies

Saturday, September 13th
Lorenzo Historic Site, Cazenovia
8:45am—Kids Pony Run
9:00 am—5K Walk/Run
Families, strollers, pets welcome!
Timing provided by Auyer Racetiming

Register at: (Little Moe 5K)
Early registration: before September 1: $25
Late registration: after September 1: $30
Includes t-shirt while supplies last

For information contact Skanda Equine at 315-882-5490
Entry  Form  
Make  check  payable  to  CNYSPCA,  and  mail  check  and  entry  form  to:  Little  Moe  5K,  c/o  Skanda  Equine,  4000  Mosley  
Road,  Cazenovia,  NY  13035.  
Name  (First  &  Last):  ________________________________________________________  

Address:  _______________________________________________________________________  

City:  ______________________  State:  ____________  Zip:  ____________  Age:  ___  Gender  _____  

Email:  ______________________________________  Phone:  _____________________  T-­‐shirt  size:  _S  _M  _L  _XL  
WAIVER  (Must  sign  to  participate):  I  do  hereby  absolve  all  race  sponsors,  volunteers,  race  officials,  and  organizers  
from  all  claims  of  damages,  demands,  actions,  and  courses  of  action  whatsoever,  in  any  manner  arising  or  growing  
out  of  my  participation  in  the  Skanda  Equine  Little  Moe  5K  Walk/Run.  I  certify  that  I  have  prepared  myself  and  that  I  
am  in  adequate  physical  condition  to  participate  in  the  event  I  have  entered  on  September  14,  2013.  
Signed  _____________________________________________Date___________  
Parent  (if  under  18)_____________________________________Date____________  

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