Mailing Address

City    State Zip      

 Phone Number    

Age:

Choose one of the following:
Female Male      

Choose one of the following:
1 Mile Fun Run Only:$25   5K Race only:$25   1 Mile Run Run & 5K Race:$30  

Choose one of the following shirt sizes:
Youth 6/8   Youth 10/12  
Adult Small   Adult Medium    Adult Large   Adult XLarge    

I accept full responsibility for my participation in the 1 Mile Fun Run and/or the 5K Race and understand that the Lumber City Womans Club is dissolved of any and all liability in the event of an accident, or any type of personal physical problem that may occur during or after the event.


Signature