The Center
Senior Meals/Meals on Wheels – 5 K Fun Walk-Run Registration

Date: Saturday March 20, 2010      8:00 am sharp
Race Day Check in: 7:30 am at Yankton Chamber Parking Lot
Proceeds go to: Yankton Senior Meals
Entry Fee: $15.00 person or $15.00 minimum in pledges
Sponsors: The Center – Yankton   Matched by Modern Woodmen Camp

 Incentives: T-shirts, provide meals “So no senior goes hungry”

Registration Information:

Name ______________________________  email address ______________________

Address _____________________________

Phone ______________________________

Email: ______________________________

Registration Fee  $ 15.00 ________________Pledges _________________

T-shirt size                    L                 Xl                2XL

Make checks payable to The Center – MOW    Total amt. paid__________

Pay Pal payment option is also available with the button below.
(registration must be completed and returned to The Center)

Please sign the waiver statement below:

In consideration of this entry being accepted, I herby for myself, heirs, executers and administrators waive and release any claims that I may have against The Center, or any of the sponsors involved in the End Senior 5 K Fun run/walk. I certify that I am physically able to participate in this event.

Signature _____________________________________ Date __________________

Please return the form to MFM 5 K Run/Walk, The Center, 900 Whiting Drive, Yankton SD 57078
Questions? Call 1-605-665-4685