5th Annual 2009 Joan Wilson 5k Entry Form

Name ____________________________________

Address  _________________________________

_________________________________________

Phone  ____________________________________

Email  _____________________________________

Age (on race day)  ____________________________

Male  _____             Female_____

Adult T-shirt size     S      M       L        XL

Youth  T-shirt size    S      M       L        XL

Entry Fee: $12.00 if postmarked by April 6th

$17.00 on race day, with T-shirt (while supplies last)

$6.00 on race day , no T-shirt

Send check and completed form to: 

Joan Wilson 5K

c/o Connie Engebretson

503 12th Ave SW

Le Mars, Iowa 51031-2905

In consideration of the acceptance of my entry, I for myself, my executors and assignees, do release and discharge all race organizers and sponsors from all claims of damages, actions and causes of actions, whatsoever, in any manner arising or growing out of my participation in said athletic event.l I hereby attest that I am physically fit and able to participate in the Joan Wilson Memorial 5K Run/Walk.

Signature  _______________________________

Parent or Guardian's signature if 18 or under 

________________________________________