ENTRY FORM
March 27, 2011
15th Annual Women Running Wild 5K Run and Walk.
Start time 8:00 a.m. for everybody
This is our celebration of women and men and the fight against breast cancer.
We honor those who have battled this disease with our emotional balloon release tribute. Not to be missed.
Benefits the Jody Klein Breast Cancer Fund and City of Hope.
2010 Run Results
Photo link: 2010
Race Director link: 2010
Phone 760 324-7069
Email greg@kleinclarksports.com
www.kleinclarksports.com
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Please Input Information on this application/Print and mail to:
Women Running Wild
80 Via Del Mercato
Rancho Mirage CA 92270
Phone and Fax; 760- 324-7069
E-mail: greg@kleinclarksports.com
Website: www.kleinclarksports.com
See your race photo at: www.brightroom.com
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REGISTRATION FEE
You can register by filling out the form in this application and mailing it with a check
"Confirmation e-mail will be sent to all participants two weeks before the event."
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General Registration 2011
$25.00 February 15, 2011
$30.00 After February 15, 2011 to March 28, 2011
Discount - Seniors 55+ and Kids 14 under $5.00 off above fees
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I cannot attend but would like to donate $ to fight Breast Cancer.
For any Ddnation please make check payable to Jody Klein Breast Cancer Fund. Tax ID: #20-4177417 |
| *Walking division is for walkers only. If you are planning to run one step, please enter in the running division. |
RUNNER:
*WALKER: |
PHONE: |
| AGE: |
T-SHIRT SIZE:
(Check one)
Small
Medium
Large
Ex-Large |
| NAME:
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ADDRESS:
SEX:
Male Female |
| CITY: |
| STATE: |
ZIP: |
*E-mail:
*Mandatory for confirmation |
Divisions Individuals (please indicate age group):
6 and under
7-10
11-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-65
70-74
75-79
80-84
85+
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Special Divisions
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WAIVER
Waiver: In consideration of the acceptance of my entry, I, for myself, my executors, administrators, as assignees, do hereby release and discharge Greg Klein, Brenda Clark, Klein Clark Sports, LLC, City of Palm Springs. And all others involved with this event from all rights and claims for damages suffered by me in said event. I also state that I am in proper physical condition to take part in said event. |
| SIGNATURE: |
DATE: |
If under 18, this waiver must have a parent's or guardian's signature.
SIGNATURE: DATE:
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