Each participant Must Complete and sign this form INDIVIDUALLY.

Make checks payable to: E H P T A

Send check & Entry Forms to:

For more information please contact: Michele Sehdev at (856) 216-0149

Full Name _____________________________________________

Street Address __________________________________________

City _______________________________ State ____ Zip Code _________

Age ______ Sex ____ 

5k Run _____   1 Mile Run ____

Race fee: $ ___________

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