APPLICATION

Women's Distance Festival - 2012 -  "Ladies Shine"

Reston YMCA, 8:00 AM, Saturday, June 23, 2012

While on-line registration is preferred, you may register for the 2012 Reston Runners Women's Distance Festival using a printed version of this form. If you mail your registration, read the program waiver carefully. Sign the form. Your signature indicates your understanding of the program waiver.

All race participants will receive a commemorative gift if registered by June 20th.  Sign up early!!

Make check payable to: Reston Runners ($35 for entries postmarked by 1 June; $40 for later submissions; Race Day Fee is $45.00)
Mail to: WDF-2012, c/o Donna Rostant, 11516 Hemingway Drive, Reston, Virginia  20194

Waiver

Event: 5K Run _______      5K Walk _______    Number (for official use only): ________

Mother/Daughter or Grandmother/Daughter/Granddaughter Team? ____(Y/N); Team mate(s): __________________________

Name (PLEASE PRINT): Last Name __________________; First Name _________________

Age/DOB: Age on race day:  ____yrs; DOB (mm/dd/yy):  ____/ ____/ ____

Address:_____________________________________

___________________, _____ ___________

Phone number: (______) _______ -- ____________

Shirt Size ___ Small         ___ Medium          ___ Large          _____X-Large

Sock Size ____ Small     _____ Medium      _____ Large

e-mail address: ________________________________

Are you a participant in the 2012 WTP? YES___ NO___

Participant Signature & Date (mm/dd/yy):

________________________________  ___/___/___

If under 18: Consenting Parent/Guardian Signature & Date

__________________________________________  ___/___/___