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Registration Form little mo .pdf

Original filename: Registration Form little mo.pdf
Title: Registration Form
Author: Ellen Beckerman

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Skanda Equine and
invite you to the 3rd Annual

Little Moe 5K Walk/Run
Sunday, June 28


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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