"A RABBIT RUNS THROUGH IT"
5K RACE REGISTRATION FORM
You can fill out this form, print it and mail to:
LATROBE - UNITY PARKS & RECREATION, PO BOX 307, LATROBE PA 15650-0307
OR if paying by Credit Card, Fax it to: 724-537-2057

PARTICIPANT INFORMATION: (PLEASE NOTE: ONE REGISTRATION FORM IS NEEDED PER PARTICIPANT)


Last Name: First Name: MI
Address:
City: State: Zip:
Area Code: Phone: Gender DOB: Age
Run Walk Shirt Size:

On conditions of this entry form being accepted, I (intending to be legally bound for myself, my heirs & executors) do hereby waive and release all rights I may have against sponsors and officials of this race, and of any and all injuries I may sustain in this event. I will obey all traffic laws, assume all risks, and am responsible for all expenses in the event of an accident. I attest that I am physically fit and have trained sufficiently for this 5K race.

Your Signature

Co-Signature (By Parent or Guardian if applicant under 18)

Payment Information:
Cash Check Credit Card Amount IF REGISTERING BEFORE April 4. After April 4, 2008 please bring the form and payment of $20 to the race.
Credit Card Type: Credit Card #:  

V-Code (last 3 digits on back of card): 
Expiration Date: Name on Card:
Billing Street Address :