Young Life Wayne County_Dash on Ash_Registration Form

Name____________________________________________ Age on May 7________ Sex_______ Street_____________________________ City________________ State_______ Zip___________ Phone________________ Shirt Size____________ Email_______________________________ Extra Donation to YL Wayne County_________________ I realize that running can be a hazardous activity, and I and my heirs, executors, administrators, and assigns do hereby release the organizers, sponsors, all race personnel, East Carolina Road Racing, and Wayne County Young Life from responsibility for any damages suffered by me as a result of my participation in this event. I also attest and believe I am healthy and ﬁt enough to safely participate in the event on May 22, 2010, and that I will take full responsibility for my own safety before, after, and during the event. Signed________________________________________________________ Date______________ Parent or Guardian if under 18_______________________________________ Date______________ Cost: $20 before May 1st, $25 after and on race day (fee includes T-shirt) Please make checks payable to Young Life Wayne County and mail to PO Box 1702, Goldsboro, NC 27533 Ofﬁcial USTAF results on ecrun.org and Facebook/YoungLifeWayneCounty SHARP TOP COVE

Transcript

Page 1: Young Life Wayne County_Dash on Ash_Registration Form

Name____________________________________________ Age on May 7________ Sex_______

Street_____________________________ City________________ State_______ Zip___________

Phone________________ Shirt Size____________

Email_______________________________ Extra Donation to YL Wayne County_________________

I realize that running can be a hazardous activity, and I and my heirs, executors, administrators, and assigns do hereby release the organizers, sponsors, all race personnel, East Carolina Road Racing, and Wayne County Young Life from responsibility for any damages suffered by me as a result of my participation in this event. I also attest and believe I am healthy and fit enough to safely participate in the event on May 22, 2010, and that I

will take full responsibility for my own safety before, after, and during the event.

Signed________________________________________________________ Date______________

Parent or Guardian if under 18_______________________________________ Date______________

Cost: $20 before May 1st, $25 after and on race day (fee includes T-shirt)

Please make checks payable to Young Life Wayne County and mail to PO Box 1702, Goldsboro, NC 27533Official USTAF results on ecrun.org and Facebook/YoungLifeWayneCounty

SHARP TOP CO

Young Life Wayne County_Dash on Ash_Registration Form

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