Name _______________________________________________
Street Address ______________________________________
City State Zip _______________________________________
Phone ____________________________________________
Email _____________________________________________
Shirt Size __________________________________________
In consideration of this entry, I, myself, my heirs, devises, executors,
administrators and assigns hereby waive, release and discharge and all
claims against Tug River Health Association and Toler Brothers Heating and
Cooling, organizations sponsoring or conducting this event or their
employees, representatives, or successors, for any and all damages or
injuries I may suffer. I hereby grant permission for free use of my name and
picture in any broadcast, brochure, or account of this event.
__________________________________________________________
Signature and Date
Street Address ______________________________________
City State Zip _______________________________________
Phone ____________________________________________
Email _____________________________________________
Shirt Size __________________________________________
In consideration of this entry, I, myself, my heirs, devises, executors,
administrators and assigns hereby waive, release and discharge and all
claims against Tug River Health Association and Toler Brothers Heating and
Cooling, organizations sponsoring or conducting this event or their
employees, representatives, or successors, for any and all damages or
injuries I may suffer. I hereby grant permission for free use of my name and
picture in any broadcast, brochure, or account of this event.
__________________________________________________________
Signature and Date
TUG RIVER HEALTH ASSOCIATION, INC.
| First Annual 5K RUN! |
Complete form and mail to:
Tug River Total Fitness Center
PO Box 507
Gary, WV 24836
Tug River Total Fitness Center
PO Box 507
Gary, WV 24836
| 5K Run October 4, 2008 Welch, WV Registration at 8:00 am Run begins at 8:30 am $5.00 Entry Fee |
1st Place: $200
2nd Place: $100
3rd Place: $50
3rd Place: $50
Sponsored by: Toler Brothers Heating and Cooling
Tug River Total Fitness Center
Tug River Total Fitness Center
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