Registration Form (Registration Form little mo.pdf)

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Skanda Equine and invite you to the 3rd Annual Little Moe 5K Walk/Run Sunday, June 28 th Location: CNY SPCA, 5878 E. Molloy Road, Syracuse Start Time: 8:30am Families, strollers, and pets welcome! Timing provided by Auyer Racetiming Early Registration (before June 15): $25 Registration after June 15: $30 For more info, contact Skanda Equine at 315-515-5056 Entry Form Make check payable to CNYSPCA, and mail check & 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: _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 June 28, 2015. Signed _____________________________________________Date___________ Parent (if under 18)_____________________________________Date____________

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