To benefit Healing House; Hope for Grieving Children

Saturday, March 23, 2013

5K begins at 7:30 am; Same-day registration begins at 7:00 am

Location: Healing House – Downtown Lafayette – 715 Lee Ave

Fee: $25 - Fee includes t-shirt

To guarantee a t-shirt – register by March 8, 2013

Packet Pick-Up: March 18-23, 2013 at Healing House Administrative Offices 715 Lee Ave Lafayette, La 70501 or March 23rd race morning at same location.

$$ CASH PRIZES FOR OVERALL MALE AND FEMALE! $$

Name: ____________________________________________________________

Address: ___________________________________ZIP Code:____________

Phone Number: __________________ Email: ____________________________

Age:________                                 T-shirt Size:________                  

Method of payment:  Check       Cash      Credit Card   ($5 Additional charge for processing)

Credit Card Number __________________________

Exp Date ______

Signature __________________________________

Mail Cash or Check to: PO Box 3861 Lafayette, La 70502