Dawson Lake Entry Form

Dawson Lake Entry Form

Dawson Lake Details

Make checks payable to:
Lake Run Club

Send to:
Jennifer Haggerty
1230 E Washington
Bloomington, IL 61701

Date/Time:
Saturday,
August 13, 2005
8:00 am

Check-in/Same Day Registration:
7:00 am - 7:45 am

More Information:
Jennifer Haggerty
Phone: (309) 827-6767

Instructions on How to Register:
Print and complete this form. Mail it with your check to the address shown on the left.

Please complete All of the following:
Name:
Street address:
City:
State:
Zip Code:
Email:
Sex:	M F
Phone:	--
Date of Birth:	- - (mm-dd-yyyy)
Age on August 13:

Select one Shirt Size:
Size:	S	M	L	XL	XXL

I Wish to Enter (select one):
5K Run/Walk	1/2 Mile Fun Run

Entry Fee (Non-refundable):
$15.00 if postmarked by August 10th	$17.00 after August 10th & Race Day
$6.00 1/2 mile fun run
Discounts:
$1.00 Lake Run Club members


In consideration of the foregoing, I for myself, my executors, administrators and assignees, do hereby release and discharge the Thursday Night Lake Run Club, The Children's Discovery Museum, and other sponsors and supporters for all claims and damages, demands, actions, whatever in any manner arising or growing out of my participation in the Dawson Lake Run. I attest and verify that I have full knowledge of risk involved in this event and I am physically fit and trained to participate in this event.


Signature (Parent if under 18)	Date