registration form .pdf
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: Active.com (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
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): ________________________________________________________
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.
Parent (if under 18)_____________________________________Date____________
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