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Apr 12th, 2010
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July 14, 2007
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Missouri Sports Hall of Fame
2007 Price Cutter Charity YMCA Y NOT RUN
Entry Form
Official Entry Form for the 2007 Price Cutter Charity YMCA Y NOT RUN
Saturday, July 12, 2008 at Missouri Sports Hall of Fame (1 Mile Run/Walk ~ 5k ~ 10k)
Non-Refundable Entry Fee
$15 per person $20 per person on race day
1 Mile Walk/Run for Fun Family Special $35/$40/$45
Pre-Registration Family of 3/4/5 Members 1 Mile Walk/Run for Fun $40/45/50 Race Day Family of 3/4/5 Members
FIRST NAME
LAST NAME
ADDRESS
PHONE
CITY
E-MAIL
STATE
GENDER
ZIPCODE
AGE
Event
1 Mile Walk & Run
5K
10K
Colothing Set Options
Full Set ($25.00)
Tank Top ($7.50)
Shorts($7.50)
Cap($10.00)
Shirt Size
S
M
L
XL
XXL
Tank Top Size
S
M
L
XL
XXL
Short Size
S
M
L
XL
XXL
Payment Method
Check
Credit Card
Credit Card Type
Mastercard
Visa
Name
Address
Phone Number
Credit Card Number
Expiration Date
Jan 01
Feb 02
Mar 03
Apr 04
May 05
Jun 06
Jly 07
Aug 08
Sep 09
Oct 10
Nov 11
Dec 12
/
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
Grand Total $
Make Checks Payable to: Price Cutter Charity Championship (PCCC)
If Check, please submit your payment with this application to:
John Q. Hammons Foundation 3861 E. Stan Musial Drive Springfield, MO 65809
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