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

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!

[ ] 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.

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

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 on /after 9/15 and Race Day (t-shirts while they last) 5K - Adult $25 Youth $20 (6 14 years old) 1 Mile Any Age $20

[ ] Registration Postmarked before 10/3 [ ] Registration Postmarked after 10/3 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.

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