DENNIS DEVLIN MEMORIAL 5K RUN - Download as DOC by 1LpRc16T

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									        DENNIS DEVLIN MEMORIAL 5K
               RUN/WALK
            MAY 19, 2007 – 11 AM
                    NEW ONLINE REGISTRATION & WEBSITE…

                      www.DennisDevlinRun.com
ENTRY FEE: $25.00 Pre-registered                                   Kids 10 & Under - $10.00
           $30.00 Day of the Race                                  Kids 10 & Under - $10.00
                         Food and Beverages provided to all runners and walkers.

                                                  OR
Make Checks Payable to:                                    Dennis Devlin Memorial Run
Completed forms may be sent to:                            Kathy Devlin
                                                           205 Beattie Rd.
                                                           Washingtonville, NY 10992
Any Questions, please email:                               devlinrun@yahoo.com

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ cut here _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
T SHIRT SIZE (Circle One)                Adult         Small Medium Large X Large XXL
                                        Children’s Small Medium Large

NAME _______________________________________________________________________

RACE CATEGORY:             RUN        or   WALK
(Circle One)

EMAIL_______________________________________________________________________


ADDRESS ____________________________________________________________________


CITY ________________________________STATE _________ZIP CODE _______________


PHONE __________________ SEX _______AGE on 5/19/07 ______BIRTH DATE ________
In consideration of my entry, I hereby for myself, my heirs, executors, administrators and assigns, waive and
release all claims and damages against the Brotherhood Winery, the village of Washingtonville and all Race
Officials for any injuries suffered by me while participating in the Devlin Memorial Run. I hereby verify that
I am physically fit and have trained for the completion of the event and that a Licensed Medical Doctor has
verified my condition.


SIGNATURE __________________________________________________________________________________________
PARENT SIGNATURE (if under 18) ______________________________________________________________________

								
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