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Entry Form Sat. April 10, 2010
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Mail Entry
Form & Entry Fee:
VMS: PO Box 223
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Age Categories: Male & Female
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| Waiver: I hereby
enter the Vergas Maple Syrup 5K Run. I enter at my own risk and
personally assume any risk or responsibility for injuries incurred as a
direct or indirect result of my participation in this event. I further
agree to not hold the Vergas Community Club or race directors or any
party associate with this race responsible.
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| Name: ____________________________ | ||||||||||
| Street Address _____________________ | City/State________________________________ | |||||||||
| Phone _____________________________ | Email ___________________________________ | |||||||||
| Sex M/F DOB _______________________ | Age on Race Day__________________________ | |||||||||
| Signature __________________________ | Signature of Guardian if under 18 years of age______________________________________ | |||||||||
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Mail Entry Form & Entry Fee: VMS: PO BOX 223 Checks made payable to: Vergas Community Club |
Good Luck!
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