REGISTRATION FORM

Registrations Postmarked before 9/15 (ensures your t-shirt) 5K - Adult $20 / Youth $15 (6-14 yrs old) 1 Mile Any Age $15 Registration Postmarked on or after 9/15 thru Race Day (t-shirts while they last) 5K - Adult $25 / Youth $20 (6-14 yrs old) 1 Mile Any Age $20 Name:____________________________ Address:__________________________ _________________________________ Email:_____________________ Please Circle: 5K Run / 1Mile [ ] Registration Postmarked before 9/15 [ ] Registration Postmarked 9/15 or after ENCLOSED: $______ Circle Tshirt Adult: S / M / L / XL Child: S/M WAIVER: In consideration of the acceptance of
this entry. I hereby waive and release all my rights and claims from damages that I or my heirs may have against HomeAID for Africa, Westtown School, West Chester Running Store, its officials, sponsors, and volunteers. I hereby certify that I have properly trained for this event and have been medically certified to be able to participate in this event. Parents sign if under 18 years of age.

HomeAID for Africa 5K RUN

1 MILE FUN WALK/RUN
SUNDAY OCTOBER 2, 2011
Run Starts 3:00 pm Westtown School in West Chester Fun Prizes!

5K RUN / 1 MILE FUN WALK/RUN HomeAID for Africa c/o John Lavin 22 W. Miner St, W.Chester, PA 19380

Proceeds benefit women and children affected by HIV/AIDS and other serious diseases in Malawi, Southern Africa.
Visit us at:
www.homeaidforafrica.org

Signature___________________Date_____ Check Payable to: HomeAID for Africa Mail To: John Lavin, 22 West Miner Street, West Chester, PA 19382

HomeAID for Africa 5K RUN

1 MILE FUN WALK/RUN
SUNDAY OCTOBER 2, 2011

REGISTRATION FORM
Registrations Postmarked before 9/15 (ensures your t-shirt) 5K - Adult $20 / Youth $15 (6-14 yrs old) 1 Mile Any Age $15 Registration Postmarked on or after 9/15 thru Race Day (t-shirts while they last) 5K - Adult $25 / Youth $20 (6-14 yrs old) 1 Mile Any Age $20 Name:____________________________ Address:__________________________ _________________________________ Email:_____________________ Please Circle: 5K Run / 1Mile [ ] Registration Postmarked before 9/15 [ ] Registration Postmarked 9/15 or after ENCLOSED: $______ Circle Tshirt Adult: S / M / L / XL Child: S/M WAIVER: In consideration of the acceptance of
this entry. I hereby waive and release all my rights and claims from damages that I or my heirs may have against HomeAID for Africa, Westtown School, West Chester Running Store, its officials, sponsors, and volunteers. I hereby certify that I have properly trained for this event and have been medically certified to be able to participate in this event. Parents sign if under 18 years of age.

HomeAID for Africa

CROSS-COUNTRY COURSE
Westtown School Cross Country Course 975 Westtown Road West Chester, PA 19382

LEAD SPONSORS

M. EFFAT, M.D. Allergy & Asthma SCUDDER G. STEVENS Attorneys at Law

The Spirit of Yoga

RUN begins 3pm REGISTRATION begins 2pm

Registrations Postmarked before 9/15 (ensures your t-shirt) 5K - Adult $20 Youth $15 (6 14 years old) 1 Mile Any Age $15 Registration Postmarked 9/15 or after and Race Day (t-shirts while they last) 5K - Adult $25 Youth $20 (6 14 years old) 1 Mile Any Age $20

Signature___________________Date_____

Visit us at:
www.homeaidforafrica.org

Check Payable to: HomeAID for Africa Mail To: John Lavin, 22 West Miner Street, West Chester, PA 19382