Meetings

Ninth ANNUAL DAVE KNOPP MEMORIAL 5K RUN/WALK

Pre-Registration Form

Saturday June 8, 2019

 

     In consideration of acceptance of this entry, I waive myself, my heirs and assigns of any and all claims of damage against the Albion Lions Club and their representatives, for any and all injuries received during, before and after this event.  I attest and verify that I am sufficiently conditioned to participate in this event.

 

Print Name:______________________________________Age:_______Male:____Female____

 

 

Signature:____________________________________________Date:______________

 

(Parent or Guardian signature required, if under 18 yrs. old on day of race)

 

Parent/Guardian signature:__________________________________Date:__________

 

Town/School:___________________________________________________________

 

E-Mail Address:_________________________________________________________

 

Adult T-Shirt sizes:

Small____  Medium____  Large____  X-Large____  XXLarge____

 

Mail Pre-Registration form to:     Must be postmarked by May 20,2019

Jim Sprague

1355 North Finlandia Way

Albion, In. 46701

Make Checks payable to: Albion Lions Club

Lions Clubs International News
Connect with Us Online
Twitter