EARLY BIRD Registration Making Tracks 5K

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Making Tracks 5K April 10, 2010

EARLY BIRD Registration


$20 Adults $15 Children

Name________________________________________ Male Female Adult


Child
First Last

Mailing
Address_____________________________________________________________________________
___
City Zip

Cell Phone __________________________ Home


Phone___________________________

E-Mail Address________________________________________ T-Shirt Size: S M L


XL

Age on Race Day_____________

In consideration of this entry being accepted I hereby for myself, heirs, executors,
and administrators, waive and release any claims I may have against Ruston High
School, Family, Career and Community Leaders of America, the City of Ruston, all
Parties, Groups, Organizations, Volunteers, Sponsors, and (or) any Representatives
involved in this event for any and all injuries suffered by me in these events. I
certify that I am in physical condition for this event.

_______________________________________________________

Total $_______________________

*Make checks payable to Ruston High School FCCLA.


*Mail form and payment to
Ruston High School FCCLA
c/o Janet Maxwell
900 Bearcat Drive
Ruston, LA 71270
*Call 318-255-0807 or e-mail caroline_weir@hotmail.com with any questions!
*All Funds Collected by registration will be sent to Children’s Miracle Network!

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