| Port
Jervis Recreation Department |
| 2009 Delaware River Run |
|
Pre-Registration Form |
| |
| 20 Hammond Street |
| Port Jervis, NY
12771 |
| Phone (845)
858-4045 |
| email:
pjrec@frontiernet.net
|
| Note: All
Pre-Registration forms must be postmarked by April 28, 2009 |
| |
|
|
|
|
Race Registration
Information |
Payment
Information |
| Date:
_______________________________________ |
Check or |
| Name:_______________________________________ |
Money Order |
| Address:_____________________________________ |
|
| ____________________________________________ |
Payable to: |
| City:
________________________________________ |
Port Jervis Recreation |
| State:___________________
Zip:________________ |
|
| Phone:
______________________________________ |
All Pre-Registration
entry's must be postmarked by April 28, 2009. Mail to address above. |
| Shirt Size (circle one)-
S M L XL
Age: _____ |
|
| Gender:
M F |
|
| Run:__________
Walk:__________ |
|
| email
Address:________________________________ |
(Sorry
No refunds) |
| |
| Disclaimer |
|
In
consideration of this entry being accepted, I, for myself, heirs and
assigns, hereby waive and release any and all claims for personal
damages I may have against the Port Jervis Recreation Commission,
City of Port Jervis, Port Jervis School District, Race Officials,
TAC and its officials and sponsors of the Delaware River Run. |
| Signature:_____________________________________________ |
|
Note: Parent or guardian's signature required if participant is
under 18 years of age. |
|
| |
| 16th
Annual Port Jervis Recreation Department Delaware River Run |
| Date:
Sunday May 3, 2009 |
| Start
Time: 9:00am |
|
Registration: 7:00am - 8:30am |
|
Location: Erie Depot, Port Jervis, NY |
| Entry
Fee: Pre-Registration Fee $15.00
(Race Day Fee $18.00) |
| Under
14: $12.00 Pre-Registration (Race
Day Fee $15.00) |
| FREE
Race T-Shirts for the First 200 Registered Runners/Walkers |
| |
| USATF Certified
5K Course |
| Certification
#NY02002AM |
|