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    2015 Registration Form Walk PDF

    Uploaded by

    Margaret Martin
    The registration form is for the 5K/10K Mile Mike Geltrude Foundation Chocolate Tour walk to be held on August 8, 2015. It requests the participant's contact information and shirt size, and allows them to choose between the 5K or 10K event, volunteer, or donate. There are early registration fees before July 13th of $30 and late fees after July 13th of $40. It notes no refunds will be provided and requires a signed waiver releasing the organizers from liability to participate.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    2015 Registration Form Walk PDF

    Uploaded by

    Margaret Martin
    21 views1 page
    The registration form is for the 5K/10K Mile Mike Geltrude Foundation Chocolate Tour walk to be held on August 8, 2015. It requests the participant's contact information and shirt size, and allows them to choose between the 5K or 10K event, volunteer, or donate. There are early registration fees before July 13th of $30 and late fees after July 13th of $40. It notes no refunds will be provided and requires a signed waiver releasing the organizers from liability to participate.

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    2015 registration form walk.pdf

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    The registration form is for the 5K/10K Mile Mike Geltrude Foundation Chocolate Tour walk to be held on August 8, 2015. It requests the participant's contact information and shirt size, and allows them to choose between the 5K or 10K event, volunteer, or donate. There are early registration fees before July 13th of $30 and late fees after July 13th of $40. It notes no refunds will be provided and requires a signed waiver releasing the organizers from liability to participate.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    21 views1 page

    2015 Registration Form Walk PDF

    Uploaded by

    Margaret Martin
    The registration form is for the 5K/10K Mile Mike Geltrude Foundation Chocolate Tour walk to be held on August 8, 2015. It requests the participant's contact information and shirt size, and allows them to choose between the 5K or 10K event, volunteer, or donate. There are early registration fees before July 13th of $30 and late fees after July 13th of $40. It notes no refunds will be provided and requires a signed waiver releasing the organizers from liability to participate.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Registration Form:

    5K/10K Mile Mike Geltrude Foundation


    Chocolate Tour WALK
    August 8, 2015 (Rain or Shine)
    Name: ________________________________________________________________________________________________________
    Address: ______________________________________________________________________________________________________
    City & State Zip: _____________________________________________________________ Phone: _______________________
    E-Mail: ________________________________________________________________Shirt Size (circle one): S M L XL
    (Shirts not guaranteed if received after 07/13/15)

    I will be participating in the following event: (for registration received after


    07/13/15 or on the day of the event, an additional $10 MUST be added)
    Mail in registration should be received no later than 7/31/15

    (before 7/13/14)

    after 7/13/14)

    The 5K Mike Geltrude Foundation Chocolate Tour WALK event ..$30.$40


    The 10K Mike Geltrude Foundation Chocolate Tour WALK event ..$30.$40
    I would like to volunteer for the event. Please contact me.
    I am not able to participate in the event, but I would like to donate the following amount:
    $____________________.

    Payment: Enclosed is a check for the total amount of $___________ made payable to Penn State.
    Please mail to: Teah Batdorf, Penn State Hershey Cancer Institute, 500 University Drive, MC CH74,
    Hershey, Pa 17033

    Please note: The event will take place rain or shine - NO REFUNDS will be provided.
    Please read and SIGN waiver to participate: I understand that participation in this type of event
    presents certain risks and hazards that may result in harm to my child or me. In consideration of my
    participation in this event, I hereby agree to release, discharge and hold harmless, on behalf of myself
    or my minor child, Pennsylvania State University, Penn State Milton S. Hershey Medical Center, their
    respective trustees, officers, agents, and employees, from all causes of action, liabilities, damages, and/or
    suits or demands whatsoever, resulting or arising from my or my minor childs participation in this
    event.

    Signature of entrant: ________________________________ Date: ______________


    **Parent/ Guardian MUST sign if under 18 years of age.

    Paid:

    cash

    check

    other____________

    For more information go to:


    www.PennStateHershey.org/chocolatetour
    www.thechocolatetour.com

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