2nd Annual

CIRCLEVILLE 4 OF JULY 5K WALK/RUN

REGISTRATION FORM
TH

Sponsored by
Piute High School Girls Basketball
Thursday, July 4th at 7 am
Course begins at Town Park by Stans

Please Mark the Appropriate Division and T-Shirt Size

___ Boys 4 and Under
___ Girls 4 and Under
___Boys 5-8
___Boys 9 - 12 Years
___Boys 13-16 Years
___Boys 17-19
___Men 20-29
___Men 30-39
___Men 40-49
___Men 50-59
___Men 60-69
___Men 70+

___Girls 5- 8
___Girls 9 - 12 Years
___Girls 13-16 Years
___Girls 17-19
___Women 20-29
___Women 30-39
___Women 40-49
___Women 50-59
___Women 60-69
___Women 70+

T-SHIRT SIZE
Youth XS

Youth S

Youth M

Youth L

Adult XS

Adult S

Adult M

Adult L

Adult XL

Adult 2X

Name (Please Print) _____________________________________________

ADDRESS______________________________________Telephone__________
Signature___________________________________________________________
(12 and under must be signed by parent or guardian)
Please mail form with payment to Wade Westwood, PO Box 222, Circleville, UT 84723

ENTRY FEE $15.00