PENTICTON LAKESIDE RESORT 5KM FUN RUN
ENTRY FORM

PLEASE PRINT

Last Name: _______________________     First Name: _______________________

Street: __________________________________       City/Prov.: _____________________

Postal Code: ___________________                    Phone Number: (___)_________________

E-mail: ___________________________

Birth Date: M_____D_____Y______                  Male ____ Female ____

Race Fee (Sorry no refunds)

Under 15 years $ 6.00                                             __________
15 years & up $11.00                                              __________
BC Athletics Day of Event
Membership Fee                                                      $ 3.00
or B.C.A. Memb. #(not Supporting)                         _________
Air-E-Ator Race Sock $10.00                                 __________
(limited quantities, circle one)             S    M    L
Late Registration Add $5.00                                    __________
(Post Marked after February 29)

                                                                TOTAL: $_________

Payable to: Penticton Pounders
Box 20056
Penticton, BC V2A 8K3

Ph: (250) 492-2929

WAIVER

In consideration of accepting this entry, I hereby for myself; my heirs, executors and administrators, waive and release any and all rights and claim, for damages of any sort that I may have against the organizers of the Penticton Lakeside Resort 5K Fun Run, their agents, representatives, sponsors, successors and assigns for any and all injuries suffered by me at the aforementioned race for damages sustained by me as a result of the aforementioned race for any cause whatsoever, including negligence.

Signature of Competitor: ___________________________________
Signature of Parent or Guardian if under 19 yrs.