April 8, 2017
Saturday 9:30 a.m.
Mayfield Hose Company
900 Maple Street, Mayfield, PA 18433
Electronic Chip Timing by Scranton Running Company
Registration Form & Waiver
Registration: 8:30—9:15 a.m. day of race
$15.00 over 18 years, $5.00 18 years and under. One free Mayfield Elementary student with paid adult registration.
Or pre-register by mailing this form to Kathy Possanza, 215 Raymond Dr, Jermyn, PA 18433 along with a check made payable to Mayfield PTA. This must be received by 3/27/17. $12.00 over 18 years, $3.00 18 years and under. One free Mayfield Elementary student with paid adult registration. One form per person please. Free student form must be attached to the paying adult form. Form may be duplicated/copied for additional entrants.
T-shirt to first 100 paid ADULT participants- Sizes will be on first come first serve basis.
Please note- if paying a student rate or receiving a free elementary student, t-shirt is not included.