2011 Fun Run Entry Form
Run or Walk Entry Fee $20
| $20
Run or Walk Additional amount will be awarded to the Alexa Foundation Prize will be awarded for the most funds raised T-Shirt Size S M L XL Please circle your choice for
both run and walk |
Make checks payable and send to:
Lewiston Kiwanis
c/o Mimi Cacciatore
5213 Bridle Path Lane
Lewiston, New York 14092
NAME: _________________________________________
ADDRESS:
_____________________________________
CITY: _________________________
STATE: _______________________ ZIP: ____________
PHONE: (____) ______________
(Circle one) GENDER: M F
RUNNERS AGE (on race day): _____________
(Please Circle one & sign )
Parent/Guardian Signature (If under18):
_______________________________
Runner / Walker's Signature:
_______________________________________
| Waver: In consideration of your accepting this entry, I hereby, for myself, my heirs, executors and administrators wave and release any and all rights and claims for damages against Key Bank of WNY, the Lewiston-Kiwanis club, its officers, agents, employees, or assignors and all other sponsors for all injuries suffered by me at said meet. |
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