Danvers Days Entry Form

Make checks payable to:
Danvers Elementary PTO

Send to:
Annie Campbell
7545 E. 1625 North Rd
Danvers, IL 61732

Date/Time:
Sunday,
August 18, 2002
7:30 am - 5K

Check-in/Same Day Registration:
6:15 am - 7:15 am

More Information:
Annie Campbell
(309) 963-6331

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-yy)
Age on Aug 18:

Select one Shirt Size (Limited Quantities):
Size:	S	M	L	XL	XXLAdd $1

I Wish to Enter (select one):
5K Run	5K Walk

Entry Fee (Non-refundable):
$18.00 if received by August 11	$20.00 after August 11
Discounts:
$2.00 Lake Run Club members	$2.00 Faculty, Staff, Student, Parent, Resident

In consideration of the my entry, I intenting to be legally bound of myself, my heir, executor and administrators, waive, release and forever discharge the Village of Danvers, Danvers Days, Danvers Elementary School, Olympia School District, the Lake Run Club, and any and all sponsors from any and all liability arising from illness, injuries or damages I may suffer as a result of participation in this event. All persons under 18 years of age must have written concent of their parent or legal guardian to compete in the above mentioned event.


Signature (Parent if under 18)	Date

Top of Page

LRC Homepage