REGISTRATION FORM

Registrations Postmarked by 10/2 (ensures

your t-shirt)
5K - Adult $20 / Youth $15 (6-14 yrs old)
1 Mile – Any Age $15
Registration Postmarked after 10/2 and on
Race Day (t-shirts while they last)
5K - Adult $25 / Youth $20 (6-14 yrs old)
HomeAID for Africa
1 Mile – Any Age $20
5K RUN
Name:____________________________
Address:__________________________ 1 MILE FUN WALK/RUN
_________________________________ A Benefit for HomeAID for Africa
Email:_____________________
Please Circle: 5K Run / 1Mile SUNDAY OCTOBER 17, 2010
[ ] Registration Postmarked before 10/3
[ ] Registration Postmarked after 10/3
Run Starts 3:00 pm
ENCLOSED: $______ Westtown School in West Chester
Circle Tshirt Adult: S / M / L / XL Child: S/M Fun Prizes!
WAIVER: In consideration of the acceptance of
this entry. I hereby waive and release all my
rights and claims from damages that I or my HomeAID for Africa
heirs may have against HomeAID for Africa,
Westtown School, West Chester Running Store,
Our Mission
22 W. Miner St, W.Chester, PA 19380

To advocate for and assist those

HomeAID for Africa c/o John Lavin
5K RUN / 1 MILE FUN WALK/RUN

its officials, sponsors, and volunteers. I hereby

certify that I have properly trained for this event affected by HIV/AIDS in Africa
and have been medically certified to be able to
participate in this event. Parents sign if under 18 especially women and children
years of age. (infected, non-infected, or
Signature___________________Date_____
orphaned).
Check Payable to: HomeAID for Africa
Mail To: John Lavin, 22 West Miner Street, Visit us at:
West Chester, PA 19382 www.homeaidforafrica.org
 REGISTRATION FORM
Registrations Postmarked by 10/2 (ensures
your t-shirt)
HomeAID for Africa 5K - Adult $20 / Youth $15 (6-14 yrs old)
1 Mile – Any Age $15
5K RUN HomeAID for Africa Registration Postmarked after 10/2 and on
Race Day (t-shirts while they last)
1 MILE FUN WALK/RUN 5K - Adult $25 / Youth $19 (6-14 yrs old)
A Benefit for HomeAID for Africa
RACE LOCATION 1 Mile – Any Age $19
Westtown School Cross Country Course
975 Westtown Road Name:____________________________
SUNDAY OCTOBER 17, 2010 West Chester, PA Address:__________________________
Run Starts 3:00 pm _________________________________
Westtown School in West Chester Email:_____________________
RACE REGISTRATION Please Circle: 5K Run / 1Mile
Registration Begins 2:00 pm Registrations Postmarked before 10/3 [ ] Registration Postmarked before 10/3
(ensures your t-shirt) [ ] Registration Postmarked after 10/3
5K - Adult $20 ENCLOSED: $______
Youth $15 (6 – 14 years old)
Circle Tshirt Adult: S / M / L / XL Child: S/M
HomeAID for Africa 1 Mile – Any Age $15 WAIVER: In consideration of the acceptance of
Our Mission Registration Postmarked after 10/3 and this entry. I hereby waive and release all my
on Race Day (t-shirts while they last) rights and claims from damages that I or my
To advocate for and assist those 5K - Adult $25 heirs may have against HomeAID for Africa,
affected by HIV/AIDS in Africa Youth $20 (6 – 14 years old) Westtown School, West Chester Running Store,
1 Mile – Any Age $20 its officials, sponsors, and volunteers. I hereby
especially women and children certify that I have properly trained for this event
(infected, non-infected, or SPONSORSHIPS and have been medically certified to be able to
orphaned). participate in this event. Parents sign if under 18
Your logo on T-shirts for donations made years of age.
by October 3rd Signature___________________Date_____
Visit us at: Product donations for prizes
Ask about signage opportunities Check Payable to: HomeAID for Africa
www.homeaidforafrica.org
Please email: africarun@verizon.net Mail To: John Lavin, 22 West Miner Street,
or call: 610-399-0823 West Chester, PA 19382
Rev.C