Pleasant Run Run - October 27, 2007
Form needs to be post marked by October 23. Web Entry Form

r5 Mile Run             r5 Mile Racewalk           r 3 Mile Neighborhood walk

First Name:______________________    Last Name:___________________________________
Address:______________________________________________________________________
City:_____________________    State:_______    Zip Code:___________________
Phone-day:__________________    Phone-eve:_______________________
E-mail Address: ___________________________________________________

Sex:    rMale        rFemale             Age:________
T-shirt size:    r S    r M   r L     r XL   r XXL   (long sleeve shirt)
FEES: 5 Mile events: $20.00 pre-registered by Oct. 23 - $25.00 on race day.
3 Mile Family walk is $15.00 pre-registered by Oct 23  - $20.00 on race day

Waiver:
In consideration of the acceptance of this entry, I waive for myself, my team, my heirs and their assigns, any and all rights and claims for damage against the Pleasant Run Run, Inc.,  and its representatives for any and all rights and claims for damages which I have or may hereafter obtain or suffer in connection with my participation in the Pleasant Run Run.  I attest and verify that I have full knowledge of the risk involved in the event.  I am physically fit and sufficiently trained to participate.

Signature:______________________________________     Date:__________________
(parent must sign if under 18 years old)
Make check payable to: Pleasant Run Run
Send entries and payment to:
Pleasant Run Run, Inc.
c/o Tuxedo Brothers
6265 Boone Ridge
Zionsville, IN 46077