Wings of Victory Outreach Corp.Presents:
Saturday, June 18, 2011 – 8:30 A.M.
(7:30 A.M. Check in & Registration – Rain or Shine)
RiverfrontPark, 140 College Drive, Pottstown
Fees: Minimum donation of $30.00required to receive a tee-shirt.(Track donations on the reverse side.)
Tee-shirts: Awarded to all participants who meet minimum donation and enter by June 5, 2011.Other qualifying participants entering after June 5th will receive tee-shirtswhile the supply lasts.
Awards: Top male and female overall.
Divisions: 10-14, 15-18, 19-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60+
Please Print ClearlyReturn Bottom
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Name ______Telephone ______
Address: ______
City/State ______Zip ______
Make check or money order payable to W.O.V. Outreach Corp., P.O. Box 242, Pottstown, PA19464
___Male ___Female Race Day Age: ______Date of Birth: ______
Shirt size: ___Small ___Medium ___Large ___X-Large____ Stroller
Note: No refunds nor mailed awards or shirts.
Race/Walk Waiver: I know that running a road race/walk is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run/walk. I assume all risks associated with running/walking in this event including, but not limited to: falls, contact with other participants, the effects of weather, including high heat or humidity, traffic and the condition of the road, and such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, formyself and anyone acting on my behalf, waive and release Wings of Victory Outreach Corp. and all sponsors, their representativesand successors from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out ofnegligence or carelessness on the part of the persons named in this waiver.
Signature:______Date: ______
Parent/Guardian signature, if under 18: ______Date: ______
Print name: ______
Emergency Contact Name: ______Phone:______
E-mail: ______
Contact us: Wings of Victory Outreach Corp., P.O. Box 242, Pottstown, PA 19464 or
Additional copies if this form may be printed from our website at
Directions to RiverfrontPark (parking lot):Take Hanover Street or Industrial Highway to
140 College Drive, Pottstown, PA 19464
The official registration and financial information of Wings of Victory Outreach Corp. may be obtained from the Pennsylvania Department of State by calling toll free within Pennsylvania - 1 (800) 732-0999. Registration does not imply endorsement.
Donations:
Name / Address / City/State/Zip / E-Mail / Amount DonatedTOTAL / $