18TH ANNUAL KINGS GRANT

WOODY PINKERTON MEMORIAL

5K RUN/WALK APPLICATION

Name ______________________________________________________

Street Address _______________________________________________

City _____________________________ State _______ Zip Code __________

Age on Race Day ________ Sex _________

Telephone _____________________________

Email _________________________________

Kings Grant Resident ___

T-Shirt Size: Small __ Medium __ Large __ XLarge __ XXLarge __

Release: In consideration of the acceptance of my entry, I for myself, my executors, administrators, and assignees do hereby release and discharge Kings Grant OSA, and other sponsors, organizers and successors from all claims, damages, actions, and causes of action whatsoever, in any manner arising or growing out of my participation in said road race. I attest that I have full knowledge of the risk involved in this event and I am physically fit and sufficiently trained to participate in this event.

Signature : (parent or guardian if under 18 ) _________________________________________________________

Mail Entries to : Kings Grant Open Space Association - 50 Landings Drive, Marlton, NJ 08053

Make Checks Payable to : Kings Grant Open Space Association