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Port Jervis Recreation Department
 2011 Delaware River Run
Pre-Registration Form
Proud Member of the 2011 Hudson Valley Grand Prix
   

 

 

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 25, 2011

 

 

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 25, 2011.  Mail to address above.
Member of 2011 Hudson Valley Grand Prix:       Y        N  
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.
 
18th Annual Port Jervis Recreation Department Delaware River Run
Date: Sunday May 1, 2011
Start Time: 9:00am
Registration: 7:15am - 8:45am
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
 

NEW IN 2011:

WALKER DIVISION WILL NOT BE AWARDED MEDALS.

WALK FOR FAMILY FUN AND EXERCISE.

USATF Certified 5K Course
Certification #NY02002AM