THIRTEENTH ANNUAL DAVE KNOPP MEMORIAL 5K RUN/WALK
Pre-Registration Form
Saturday June 11th, 2022
In consideration of acceptance of this entry, I waive myself, my heirs and assigns of any and all claims of damage against the Albion Lions Club and their representatives, for any and all injuries received during, before and after this event. I attest and verify that I am sufficiently conditioned to participate in this event.
Print Name:______________________________________Age:_______Male:____Female____
Signature:____________________________________________Date:______________
(Parent or Guardian signature required, if under 18 yrs. old on day of race)
Parent/Guardian signature:__________________________________Date:__________
Town/School:___________________________________________________________
E-Mail Address:_________________________________________________________
Adult T-Shirt sizes:
Small____ Medium____ Large____ X-Large____ XXLarge____
Mail Pre-Registration form to: Must be postmarked by May 25,2022
Jim Sprague
1355 North Finlandia Way
Albion, In. 46701
Make $20 Checks payable to: Albion Lions Club
