A
4 Mile Run and Walk To Benefit
The
Kelsey Mikel Memorial Foundation
November 24, 2011
8:00 a.m.
NorthWood High School
Nappanee, IN
NAME AGE SEX M F
ADDRESS
PHONE
EMAIL
T-SHIRT
SIZE S M L XL XXL Child S M L
EVENT 4 MILE RUN 4 MILE WALK 2 MILE RUN 2 MILE WALK
COST $20 prior to November 10
$25 November 10 to November 23
$30 RACE DAY ENTRY
$75 FAMILY ENTRY prior to November 10 (members of same household)
Make checks
payable to and mail to:
Kelsey Mikel Memorial Foundation
29284 County
Road 36
Wakarusa,
IN 46573
Additional donations
may be included with your entry.
Donations are tax-deductible.
Proceeds
from the race will benefit the Kelsey Mikel Memorial Foundation to help provide
a scholarship to a NorthWood High School students continuing on to college.
In
consideration of my participation in this event, I for myself, my heirs,
executors, and administrators, waive all rights and claims for damages I may
have against the Kelsey Mikel Memorial Foundation, the town of Nappanee, Wa-Nee
Community Schools, the sponsors of this event, their agents, representatives,
successors, and assignees for any and all injuries suffered by me at said
event, or which may arise out of my traveling to, participating in, and
returning from this event. I further state that I am in proper physical condition
to compete in this event.
Signature Date
Guardian
Signature if under 18