First Name:___________________________ Last Name:_________________________________

Address:________________________________________________________________________

City:___________________________   State:____________________    Zip:________________

Circle the following shirt size:

Shirt Size:  YS (6-8)   YM(10-12)   YL(14-16)

Adult Sm.   Adult Med.   Adult Lg.   Adult XL

Registration & Fees:

Forms must be received by August 27, 2008

$20 Registration fee (Ages 18 - adult)

$10 Registration fee (Ages 5-17)

$40 Registration fee (Family)

Pre-registered individuals will receive a free t-shirt

Pre-registered families will receive 3 total free t-shirts

Additional shirts may be ordered for $7.00

Checks payable to: Francesville Fall Festival

Day of event registration fee will be an additional $5

Registration will begin at 7:00 A.M. at the high school

Waiver of claim: (must be signed or entry is invalid)

I assume responsibility for my own safety and those family members I have registered above. I recognize the hazards and risks involved in walking/running and agree that the City of Francesville and the Fall Festival are not responsible for any accidents or incidents that may occur.

Signature: ________________________________

Signature of parent or guardian if under 18 years of age: ___________________________________

Date: ____________________________________