yellow entry Form .pdf

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Original filename: yellow entry Form.pdf
Author: Bruce Hall

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Twelfth Annual 8K Run and 5K Walk
Beautiful Course through Scenic Chittenango!
Info on Chittenango Lions Website
http://chittenangolions.org/Events/YBRR/YBRR.html
ATF Certified NY12076JG
Sponsored By The Chittenango Lions Club and Community Volunteers

Sat. June 27, 2015
Check In At 7:30 a.m.
Free Fun Run at 8:30
Race to Start at 9:00 a.m.
Starting and ending at the Chittenango Fire Barn

Pre-registration $20

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Day of the Race Registration $25

Online Registration: http://www.chittenangolions.org/Events/YBRR/Online_Reg_Form.html
Free Fun Run for Youths Under 16
Electronic Timing by Chittenango Cross Country Club
Age Group Awards: 3 awards, male and female in the following age groups
12-15, 16-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70 and above
In consideration of accepting this entry, I the undersigned, intend to be legally bound, hereby for myself, my heirs, executors, and
administrators, waive and release any and all claims for damages I may have against the sponsors, race officials and volunteers, and
assignees, for any and all injuries suffered by me in said event. I also attest to and verify that I am physically fit and have trained
sufficiently for the completion of this race.
T shirts for all paid runners.
Refreshments for all runners.

Mail to: Stephen D. Waite
6990 Bolivar Road
Chittenango, N.Y. 13037
Checks Payable to: Chittenango Lions Club
315-687-7114
<Waites30@hotmail.com>
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Last Name

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First Name

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MI

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Sex

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Street Address

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Zip

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City

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Phone Number

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Fun vRun

8K Run

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Shirt Size

5K Walk

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State
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Age (as of June 28, 2015)

Signature:
____________________________________________________________________________________________________________________________________________
Parent Signature (under 18):
_____________________________________________________________________________________________________________________
Email address:
_______________________________________________________________________________________________________________________________________
*** Donations gratefully accepted to the Town of Sullivan Food Cupboard ***


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