Contact: Lynette Finley, WCHS FBLA Adviser @lfinley@esu6.org or Phone __________
Please make checks payable to: Wilber-Clatonia FBLA - $20 if received by July 20.
$25 after July 20.
Mail to: Duck and Dumpling Run, WCHS, P O Box 487, Wilber, NE 68465
NAME (Last, First) Please print__________________________________________________
Gender: Male Female Race: 10K______2-Mile______
Mailing Address__________________________City________________State______Zip______
Age_______DOB___________Phone________________ Email: __________________________
T-Shirt Size (Circle One) Child S / Adult S M L XL XXL XXXL
In consideration of your acceptance of my entry, I hereby for myself, my heirs and executors, waive and release any and all rights and claims for damages against the Wilber-Clatonia FBLA, the City of Wilber, Saline County, and the meet officials for any injuries suffered in connection with this event.
I further certify that I am in good health and physical condition to participate in this event.
______________________________________________________________________________ Date Entrant Signature and if under 19 Signature of Parent or Guardian.