Phone: 610-593-6854

To contact us: Atglen Borough
                     120 Main Street
                     P O Box 250
                     Atglen, PA  19310

  

 

ENTRY FORM

Please print this form and mail to the following address:

Covered Bridge Classic    
C/O Atglen Borough
P O Box 250
Atglen, PA  19310 

Make checks payable to: Atglen Borough

Please print

 

Age __ __              Male __   Female __         Circle one event:

                                                                          1 Mile run           5k Run

                                                                          5K Walk             10 Mile Run

 T-Shirt Size   S  M   L   XL

 

Last Name __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

First Name __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Street __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

City __ __ __ __ __ __ __ __ __ __ __    State __ __     Zip __ __ __ __ __

Phone __ __ __   __ __ __   __ __ __ __

 

All races/walks = $12.00   Mile fee = $6.00  T-shirts upon availability after 10-11-07, $15.00 fee on Raceday for all races except 1 mile.  In consideration of this entry being accepted, I, intending to be legally bound, hereby for myself, my heirs, executors, administrators, waive and release any and all right I might have against CBC, Inc., Atglen Borough, Christiana Borough, West Fallowfield, West Sadsbury, and Sadsbury (Lancaster County), Townships, property owners, its agents, representatives, successors, and assigns for any and all injuries suffered to me in said race.

 

 

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Signature                                                                                                      Date

 

 

 

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Parent's signature required if less than 18 years old