Burgh's Pizza & Wing Pub
8th Annual 10K Run

Sunday, April 20th 2008

for family, friends, & fun

Benefit of the Montour Trail
ENTRY FEES Adults Children
under 12
10K Fee    $25    $20
2-Mile Walk Fee    $25    $10


Make checks payable to:
BP&W 10K Montour Trail
(Please do not sent cash.)


Mail to:
BP&W 10K Montour Trail
533 Washington Ave.
Bridgeville, PA 15017
  Please print
Name:
Address:
 
City:
State, Zip:
Age as of April 20, 2008: _____
Sex:   M      F
Event: 10K Run      2-Mile Walk

Dri-release Micro blend Running Shirt Size:
S     M     L     XL
Waiver: In consideration of the acceptance of this entry, I waive for myself, my heirs, and assigns, all rights and claims for damages which I might have against the Burgh's Pizza & Wing Pub 10K Run for Family,  Friends & Fun to be held Sunday, April 20, 2008, Burgh's Pizza & Wing Pub, The Montour Trail Council, other sponsoring organizations, businesses, or individuals as a result of any and all injuries suffered by me in that event. I attest and verify that I am an amateur and physically fit and have trained sufficiently for this event. I also release any photos that may involve myself.
Signature:
If under 18, parent or guardian must sign below:
 
Signature of parent or guardian