Runners Soul Moonlight Run March 13, 2004 -7:30 PM, Lethbridge Alberta
Please fill out entry print and mail with cheque, money order or VISA # to:
Runner's Soul Moonlight Run
2646 South Parkside Dr.
Lethbridge, AB. Canada
T1K 0C4

Last Name:

First Name:

Mailing Address:

City:

Prov./State

Postal/Zip Code:

Ph. w/ Area Code:

(IMPORTANT in case we need to contact you regarding entry info):


EVENT ENTERED:

6K MALE
6K FEMALE
10K MALE
10K FEMALE

Sorry NO WALKING 10KM
Sorry NO STROLLERS or PETS

AGE CATEGORY: As of March 13th/2004:

11&Under
12-15
16-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-79
80+

Sweatshirt size:

S
M
L
XL
XXL(add $3)

Liquor Ticket :
MUST be 18 years of age or older

Yes
No

Entry Fee: All entries include party tickets
$25.00 Entry Fee WITH Shirt
$15.00 Entry Fee WITHOUT Shirt
$20.00 Late Entry Fee:(AFTER MARCH1/03) NO SHIRT (if space available)
$3.00 XXL Shirt Surcharge
Please includeextra Pizza Tickets at $2.00 each
Please includeextra Beer/Wine Tickets at $2.50 each
Add $1.00 ONLY IF paying by VISA (processing fee)

Payment Method:

VISA
Cheque
Cash

VISA #ExpDate
Signature:__________________________________

TOTAL ENCLOSED:$ No Changes in Distance Choice after Mar 6/2003

Tell Us About Your Self to Help out Our Finish Line Announcer STEVE KING:
Occupation/ School Attended:

Goal in this Moonlight Run:

Is March 15 a Special Day for You?

Age: Birth Date:

Number of Previous Moonlight Runs

Fastest Moonlight Run
mins:secs 10Km | 6Km

Future Goals:

PLEASE, PLEASE make sure form is COMPLETELY Filled out!!
Cash ,VISA or Cheques( NO POST DATED CHEQUES) only , No Race confirmation sent out
"SORRY" NO REFUNDS

Please read and sign following Waiver:

In consideration of your acceptance of this race entry, I, for myself, my heirs, executors, administrators and assigns, foreverwaive, release and discharge any and all rights, demands, claims for damages and causes of suit or action known or unknown,that I may have against Runner's Soul Moonlight Run and any and all participating race sponsors and supporters and directors,officers, employees and agents of such parties, for any and all injuries in any manner arising or resulting from my participating insaid race. I attest and verify that I have full knowledge of the risks involved in this race, that I assume those risks, that I willassume and pay my own medical and emergency expenses in the event of accident, illness or other capacity, regardless ofwhether I have authorized such expenses and that I am physically fit and sufficiently trained to participate in this race.

Print Name:_____________________________
Signature:______________________________
Signature of Parent or Guardian if under 18 years of age:___________________________________

MoonLight Run Reminders

Race Date - March 13/2004

Race Location - Park Place Mall Lethbridge Alberta

Race Time - 7:30 PM

Race Package Pick-up - Park Place Mall -
6:00pm-9:00pm Friday March 12/2004
10:00am-5:30pm Saturday March 13/2004
SORRY NO REFUNDS