Concord Trinity United Methodist Church

5K Walk For Ghana

August 15, 2009
9:00 A.M.
Clydesdale Park – Lawrence J. Hensler Shelter
9801 Green Park Rd., St. Louis, MO 63123
Contact: Lisa Snow at 314-583-1578

PARTICIPANT REGISTRATION FORM

Registration Deadline is July 25 to guarantee t-shirt

First Name_______________________________ Last Name____________________________

Address_____________________________________________________________________________
City_____________________________________________ State_________ Zip ______________
Phone: Home (____) _________________________ Work: (____)___________________________
Cell : (____) Email: _________________________________

5K Adult Registration ($25.00 fee 5K Child Registration (ages 6-12,

$10.00, Includes Includes T-Shirt) free prizes)

5K Child Registration (age 5 and under are free)

T-Shirt Size, all are adult sizes (Circle One): S M L XL

Payment Information: I would like to pay by (circle one): CASH CHECK

Please make all checks payable to CTUMC, and note Ghana on the memo line.

____ I am unable to participate, please accept my contribution of $ ________

CTUMC Ghana Walk Waiver

Waiver must be signed to participate in walk.

In participating in the Ghana Walk, I hereby release and agree to indemnify and hold harmless Concord Trinity United
Methodist Church, and all officers, directors, employees, agents, affiliates, successors, and assignees of Concord Trinity United
Methodist Church to the fullest extent allowed by law, from and against any and all claims, injuries, damages, and/or losses I may
incur or suffer as a result of my participation in any Concord Trinity United Methodist Church activity.

Signature Date

Date
Parent Signature required for participant less that 18 years of age.

Please send this form and payment to: Concord Trinity United Methodist Church
Attn: Walk For Ghana
5275 South Lindbergh Blvd.
St. Louis, MO 63126