Mailing Address

 City    State   Zip      

 Phone Number    

Age:

Choose one of the following:
Female    T Male           

Choose one of the following:
5K Fun Run:$25   1 5K Race:$25  

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


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