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Treasure Your Chest Run/Walk Registration Form
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TREASURE YOUR CHEST RUN/WALK

SATURDAY, SEPTEMBER 25TH, 2010

DOWNTOWN YOUNGSVILLE

Please join us at Adagio Health Warren's 5K Run/Walk
to benefit Adagio Health's Cancer Screening and Community Education departments.
 

Saturday, September 25th, 2010
Downtown Youngsville
Rain or shine!
Sign Up begins at 7:30 a.m. at the Youngsville Fire Hall
5K Run begins at 9:00 a.m.
1 Mile Walk begins at 9:15 a.m.
 

$15 for adults to pre-register using the form below.

Deadline to pre-register is September 17th.
$20 for adults to register the day of - 5k
$5 for children (under the age of 12) - 5K
$5 for those ages 65 and older - 5K
$5 for any participant in the race, walk or roll - 1 Mile
Free for those in wheelchairs or using strollers

ONLY CASH OR CHECKS WILL BE ACCEPTED THE DAY OF THE RACE

First 175 registrants will receive a free T-shirt!
Awards and prizes!
AFTER PARTY AT ISLAND PARK FOLLOWING RACE!

To pre-register by phone, please call the Adagio Health Warren Office at 814-723-5852.

Registration Fee (Please select the appropriate choice when registering)
     

5K Adult participant (Pre-registration offer): $15.00
5K Child participant (under the age of 12): $5
5K Senior Citizen participant $5
1 Mile participant $5
Wheelchair/Stroller participant: FREE

     
T-Shirt Size (Please select one)
Youth:
S M L
Adult:
S M L XL XXL
First 175 registrants will receive a free T-shirt!

 

PLEASE READ AND AGREE
I do hereby release and discharge Adagio Health and all event volunteers from any and all liability arising from any illness, injury, or damages I may suffer as a result of my participation in the Treasure Your Chest Walk/Run event.
Name:
Mailing Address:
City:
State:
Zip Code:
Email:
Home Phone:
Emergency Contact/Phone:
 
Payment Information
 
Credit Card Number:
CVV2:
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Expiration Date:
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Questions? Comments? For more information, contact Adagio Health.
© 2010 Adagio Health. Please read our disclaimer.
Last updated August 5, 2010.