2004 TWILIGHT 5K ENTRY

Race Sponsored by LCSC Cross Country

  __________________________________________________________________
 Registration Form (Please Print)


Name:____________________________       Age:____               Gender:        M   or   F   

Address:___________________ City:__________ State:_____ Zip:______  Phone:_________

EMAIL: ______________________________________________________________

Check One:        5k RUN____        5k Walk_____                

Check One:        With T-Shirt_____ Size:   XL    L    M    S           Without T-Shirt _____

Costs:    Prior to April 7th        With T-Shirt - $12.00        Without T-Shirt - $7.50

                After April 7th            With T-Shirt - $17.00        Without T-Shirt - $12.50

Make checks payable to LCSC Cross Country

Please read the following statement and sign below before submitting entry.
 In consideration of the acceptance of my entry, I do hereby acknowledge that I assume all risks resulting therefrom, and I do hereby, for myself, my heirs, my executors and/or administrators, waive, release, and forever discharge any and all sponsors and organizers, their officers, agents and assigns, the race director and volunteers from any and all liability arising from illness, injuries, or damages I may suffer as a result of my participation in the TWILIGHT 5K . I understand that traffic control on the course will be limited and that I must watch for vehicles at intersections and on the roadway. This entry is non-transferrable and non-refundable.

 

Signature: _________________________________ Date:__________

Parent/Guardian (if under 18 years of age): __________________________Date: __________

Mail Entry Form and Fees to: