George Dales Invitational

Open 5K Entry Form

Site: Pine View Golf Course, Three Rivers, MI

Date: Friday, September 24, 2004

Time:   4:30 Men’s 8K

   5:15 Women’s 5K

   5:45 Open 5K (Men & Women combined)

Entry Fee: $5 per person (Pay in cash on the day of the race or make check payable to

   Western Michigan University)

Entry Deadline: Monday, September 20th

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LAST NAME: _________________________ FIRST NAME: ___________________

ADDRESS: ______________________________________________

   ______________________________________________

   ______________________________________________

PHONE #: _______________________________________________

In consideration of my participation in this event, I for myself, my heirs, executors, and administrators, waive all rights and claims for damages I may have against Western Michigan University, the sponsors of this event, their agents, representatives, successors, and assignees for any and all injuries suffered by me at said event, or which may arise out of my traveling to, participating in, and returning from this event. I further state that I am in proper physical condition to compete in this event.

Signature: _____________________________________ Date: ______________

Please fax this form to Becki Bishop at 269-387-1026 or email to becki.bishop@wmich.edu. Thank you for participating!!