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Sunday, May 27, 2007 -- Point Marion, PA
Albert Gallatin Regatta 5K - MAGP Sprint #4 (iPO Event Id#: 10047)

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Make check payable to: Albert Gallatin 5K and mail to:
Albert Gallatin 5K, C/O Mary Hubeaut, 215 Prospect St., Point Marion,Pa.15474



CITY:___________________________________STATE:_____ ZIP:__________

CHECK ONLY ONE: 5K RUN______ 5K WALK______

T-Shirt Size - M____L____XL____ Male_____ Female_____

DATE OF BIRTH __________/ __________/ ___________ (month/day/year)

Race Waiver - Must be signed!
In consideration of your acceptance of my application for the entrance in the Albert Gallatin 5K Run & 5K Walk, I, for myself and anyone entitled to act on my behalf, waive and release the Albert Gallatin 5k, the Race Director, and all sponsors, volunteers, officials, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event.

Signature (required)

Parent or Guardian MUST SIGN if under 18