Make checks payable to: Firecracker 5k

Fill in the information, print it out, and mail to:
Gary Moenck
2782 Boone River Dr
Webster City, IA 50595

Race day: Friday, July 4th, 2008 at 8:00 a.m.

First Name:
Last Name:
Email Address:
Street Address:
City:
State:
Zip Code:
Phone #:	() -
Country (if not USA)
Gender:	Male   Female
Your age on race day:
-Shirt Size- Kids - S Kids - M Kids - L S M L XL XXL - add $1	-Race- $12 - 5k Race Early Entry $17 - 5k Race Late Entry (after June 28) $7 - Kids Fun Run $10 - Kids Fun Run (after June 28)
Note: Cannot guarantee t-shirts for everyone who signs up on race day In consideration of acceptance of this entry, I waive and release the City of Webster City and Recreation Department, supporting organizations, sponsors, contributors, race officials, and volunteers from liability for any injury or accident I may suffer during the course of this event.
I agree to the above waiver
Date: