ENTRY FORM
March 29, 2009
12th Annual Women Running Wild 5k run/walk
Ruth Hardy Park- Palm Springs
Benefiting- Jodi Klein Breast Cancer Fund
Phone 760 324-7069
Email greg@kleinclarksports.com
www.kleinclarksports.com
2008 Race Results |
Please Input Information on this application/Print and mail to:
Women Running Wild
80 Via Del Mercato
Rancho Mirage CA 92270
Phone and Fax; 760- 324-7069
E-mail: greg@kleinclarksports.com
Website: www.kleinclarksports.com
See your race photo at: www.brightroom.com
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REGISTRATION FEE
You can register by filling out the form in this application and mailing it with a check
Or  |
General Registration 2007
Before March 1, 2008 $25.00
After March 1, 2007 and after $30.00
14 Under & 55+
Before March 1, 2008 $19.00
After March 1, 2008 and after $25.00
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I cannot attend but would like to donate $ to fight Breast Cancer.
Make check payable to Jody Klein Breast Cancer Fund. |
| *Walking division is for walkers only. If you are planning to run one step, please enter in the running division. |
RUNNER:
*WALKER: |
PHONE: |
| AGE: |
T-SHIRT SIZE:
(Check one)
Small
Medium
Large
Ex-Large |
| NAME:
|
ADDRESS:
SEX:
Male Female |
| CITY: |
| STATE: |
ZIP: |
*E-mail:
*Mandatory for confirmation |
Divisions Individuals (please indicate age group):
6 and under
7-10
11-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-65
70-74
75-79
80-84
85+
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Special Divisions
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WAIVER
Waiver: In consideration of the acceptance of my entry, I, for myself, my executors, administrators, as assignees, do hereby release and discharge Greg Klein, Brenda Clark, Klein Clark Sports, LLC, City of Palm Springs,
And all others involved with this event from all rights and claims for damages suffered by me in said event. I also state that I am in proper physical condition to take part in said event. |
| SIGNATURE: |
DATE: |
If under 18, this waiver must have a parent's or guardian's signature.
SIGNATURE: DATE:
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