North Warren Relay Team’s 1st Annual

Date: 3/6/2010
Time: 07:00 AM - 10:00 AM
Location: North Warren Elementary School

North Warren Relay Team’s 1^st Annual

Run For Ruth Ann

benefiting the

March 6, 2010

North Warren Elementary School

Registration begins at 7:00 AM

5K Run at 8:00 AM, 5K Walk at 8:05 AM,

1 Mile Fun Walk at 8:10

REGISTRATION FORM

LAST NAME __________________ FIRST NAME__________________

EMAIL___________________________________PHONE___________

MAILING ADDRESS CITY_____________________________________

STATE _______ZIP____________ MALE________ FEMALE_________

AGE (as of 3-06-10) _____________

EVENT

􀀀 5K Walk

􀀀 5K Run

􀀀 1 Mile “Fun Walk”

SHIRT SIZE: S M L XL XXL XXXL (ADD $2.00 for XXL or XXXL) or Children’s Shirt: S M L

(t-shirt if registered by 2/26/10)

*Pre-Registration (Must be postmarked by 2/26/10!)

*Individual Entry - $20 Late Fee (after 2/26/10) $25 $_______

Donations collected $_______

Total Amount Enclosed $ $_______

Make checks payable to American Cancer Society

Release: I should not enter in the North Warren Relay for Life Run/Walk unless I am medically

able and properly trained. I agree to abide by any

decision of a race official relative to my ability to safely complete the event. I assume all risks

associated with running and/or volunteering to participate

in the event. Having read this waiver, I myself, or anyone entitled to act on my behalf, waive and

release the City of Smiths Grove, Warren County,

North Warren Relay team and all members thereof, and all sponsors from all claims of

any kind arising from my

participation in the aforementioned event.

Participant _____________________________ Date_____________

(Signature)

All Fees are Non-refundable. Return enrollment form to North Warren Elementary,

c/o Christi Beam, 420 College St.,

Smiths Grove, KY 42171 For more information call (270)563-2041

ex. 2012 or 270-563-2041 ex.3030