Thursday, June 12, 2008 -- Connellsville, PA
Francis "Bud" Murphy Memorial 5K (iPO Event Id#: 10954)

Presented by the Highlands Hospital

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ENTRY FROM (Please Print)                         RACE NO.________
                                                 (Offical use only!)
NAME___________________________________________________
 
ADDRESS________________________________________________

CITY________________________STATE_______ZIP____________

PHONE__________________________________________________

AGE ON RACE DAY_________________BIRTHDATE______________

MALE___ FEMALE___ RACE SELECTION: 5K RUN___ 5K WALK____

SHIRT ZIZE (Please circle one): S  M  L  XL  2XL  Youth

WAIVER: In signing this entry, I hereby release Highlands Hospital from any claims or responsibility for any injuries suffered by me in this event.

_______________________________________________________
SIGNATURE  (If under 18, Parent or Guardian MUST sign)

* Entry not valid unless all information herewith is filled out and signed.
* Results will be posted after the race.

Entry Fee: $15.00 Pre-Registered, $17.00 on Race Day
Please make checks payable to: Highlands Hospital

Mail entry forms to:
Highlands Hospital
401 East Murphy Avenue
Connellsville, PA 15425