Relay for Life 5K Race

COLORS OF HOPE 5K WALK/RUN

Saturday, May 16, 2015
Registration at 8:30 am
Race starts at 10 am

Being held at the Hess Field Pavilion

Registration form:


Name: __________________________________________

 

Age (at race date)/gender: _____________________________

 

Address: ________________________________________

 
City, State, Zip: ___________________________________

 
Phone (      ) - _______ - ________

 
Emergency Contact (name and phone number): ____________________________________


T-Shirt size(s): ­­­­­­­­­­­­­­­­________________


Entry Fee: Please make your check payable to the American Cancer Society, 1948 East Third Street Williamsport, PA 17701.  Return form and fee to: Kayla James at PO Box 82, Danville, PA 17821.  Any questions contact Kayla at [email protected].

• Registration before April 24 (includes T-shirt): $20
  
  

• Registration on or after April 24 (T-shirt not included): $25
  
  
• Children 12 years old and younger: free
  
   
  
  Disclaimer: For and in consideration of permission to participate in this race, I for myself, my heirs, executors and administrators, do hereby release and discharge the sponsors, contributors, officials, employees and all of the members and officers of the American Cancer Society, Relay For Life, the borough of Danville, PA, from all claims and damages arising from my participation in this race. I attest and verify that I am physically fit and have sufficiently trained for this event.
  
   
  
   
  
  Signature/Date: ________________________________________________________
  
  (Parent Signature if under 18)