Shenendehowa Participant's Release Form

Thursday

May 15, 2008 6:25 pm

Entry Fee (per person): due April 25th
$25.00 for registration and Cotton T shirt

$30.00 for registration and a Racing Quality Tank Shirt

Add an additional $8.00 to the total if you plan on eating at the after race gathering TBD

 

-No Race Day Entry No  Substitutions-

 

 

  1. Please fill in the information sheet below
  2. After completion hit the "Submit Button"
  3. Print out a copy of your "Participant Release Form" 
  4. Return the "signed" Participant Release Form with payment (checks can be made payable to Paul Ripchik) to your Building Captain. 

    Should you have any questions, please contact or e-mail Paul Ripchik at ext. 61430, or ripcpaul@shenet.org

 

 

Please provide the following information:

Sex Male        Female
First Name
Last Name

Building

Work  ext.
Home Phone
SHENET E-mail

Shirt Size (S,M,L,XL):

Style: : Tee Shirt        Tank

RSVP

(Attend Post Race Party)

.

 Yes       No

                  

Acadia Margaret McMahan
Transportation Dave Christopher
Building/Maint/Bus Joe Mayo
Chango Neil Kelsey
DO Chris Wormuth
East Larry Silverman
Gowana Vanessa Alderman
IMS Mark Nirsberger
Karigon Dyan Douty
Koda Nicole LePage
Okte Lisa  Nieradka

Tesago/Arongen Orenda

 Send to Paul Ripchik

@ HSE
West Megan Peterson
Shatekon Jaime Semered  
  Skano Ryan Fenton

 

Please read the Agreement and Release below prior to submitting your information. 

 

 

 
Maintained in accordance with the Shenendehowa Central School District Web Publishing Guidelines by Meg Springli, HSE Computer Lab.
Copyright © 2006 All rights reserved.
Revised: 04/21/08