Port Jervis Recreation Department

 2010 Delaware River Run

Pre-Registration Form

Member of the 2010 Hudson Valley Grand Prix  (10th Anniversary)

20 Hammond Street

Port Jervis, NY 12771

Phone (845) 858-4045

email: pjrec@frontiernet.net


 

 

Race Registration Information

Payment Information

Date: _______________________________________

Check or

Name:_______________________________________

Money Order

Address:_____________________________________

 

____________________________________________

Payable to:

City: ________________________________________

Port Jervis Recreation

State:___________________ Zip:________________

 

Phone: ______________________________________

All Pre-Registration entry's must be postmarked by April 26, 2010.  Mail to address above.

Shirt Size (circle one)- S  M  L  XL                   Age: _____

 

Gender:      M      F

 

Run:__________          Walk:__________      

 

email Address:________________________________

(Sorry No refunds)

Disclaimer

In consideration of this entry being accepted, I, for myself, heirs and assigns, hereby waive and release any and all claims for personal damages I may have against the Port Jervis Recreation Commission, City of Port Jervis, Port Jervis School District, Race Officials, TAC and its officials and sponsors of the Delaware River Run.

Signature:_____________________________________________

Note: Parent or guardian's signature required if participant is under 18 years of age.

 

 

17th Annual Delaware River Run

Date: Sunday, May 2, 2010

Start Time: 9:00 am

Registration: 7:00 am-8:30 am

Location: Erie Depot, Port Jervis NY

Entry Fee: Pre-Registration $15.00 ($18.00 race day)

Under age 14 Pre-Registration $12.00 ($15.00 race day)

FREE Race T-shirts to the First 200 Registered runners/walkers

USATF CERTIFIED 5K COURSE-CERTIFICATION #NY02002AM