Haven in the Hardwood
5k Run and Walk
March 17, 2012
Run_____ OR Walk_____ Female_____ OR Male_____
Age on 3/17/2012___________
T-Shirt size: S_____ M______ L_____ XL_____
T shirts are guaranteed to all who pre-register!
Pre-registration fee $10 post marked March 9, 2012 _________________
After March 9 and Race Day registration fee $13 ___________________
For and in consideration of my participation in the Haven in the Hardwood 5K in Pickens, WV, I release the sponsors, the program, its members, volunteers, co-sponsors, landowners and other participants from any claim for injury or loss that occurs to me or my child/ward or anyone on his or her behalf. I therefore attest and verify that I am physically fit and have sufficiently trained for this event.
Please make checks payable to: Pickens Improvement & Historical Society, PIHS
Haven in the Hardwood 5K
PO Box 94
Pickens, WV 26230
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