|
Send registration to: Kerry Slocum, Pioneer Corps (Make checks payable Pioneer High School to Pioneer Corps.) P.O. Box 639 Yorkshire, NY 14173 For more information, please contact Kerry Slocum at kslocum@pioneercsd.org or 716.353.6216. - - - - - - - - - - - - - - - - - - - - - - (detach before mailing)—- - - - - - - - - - - - - - - - - - - - - - - - - Pre-registration (must be received by May 18, 2010): $15 Sorry, no refunds. Race-day registration: $20 T-shirts will be provided to the first 200 registrants. Shirt size: S M L XL Please print the following information: Name: Gender: M or F Street Address: Age on race day: City/State/ZIP: (age required for award eligibility) Phone: Run Walk Waiver (must be signed to participate): I waive and release any and all rights and claims for damages for me, my heirs, executors and administrators that I may now or in the future have against Pioneer Corps, Pioneer Central Schools, and the Village of Arcade, event sponsors, their representatives, agents, and/or assigns for any and all losses suffered during or as a result of competing in 4 for the Corps. In addition, I understand that participating in an event of this kind is physically strenuous, and I certify that I have not been advised by a medical professional that I should refrain from participating. Participant’s signature: Parent’s signature (parent/guardian if under the age of 18): |
|
Arcade Village Park |