William Carey College

Fellowship of Christian Athletes

5K RUN / WALK

Sponsored by: Partnership for a Healthy Mississippi on Campus

REGISTRATION FORM:

Saturday October 2, 2004

Name: __________________ (male) or (female)

Phone Number: __________________

Address: __________________

__________________

AGE: (circle one) 12 and under 13-19 20-29 30-39 40-49 50+

T-SHIRT SIZE: (circle one) small medium large XL XXL XXXL

REGISTRATION FEE: $15 pre=registration $20 day of race

**WCC Students $10**

Please make checks payable to: Fellowship of Christian Athletes

498 Tuscan Ave. WCC Box #172

Hattiesburg, MS 39401

*For more information and questions contact:

Brandon Roney (601) 318-6350

Audrey Morgan (601) 318-6444, email: amorgan@wmcarey.edu

Get your online registration application at:

http://www.pinebeltpacers.org/Races.html#William_Carey_College

Proceeds will go to the American Heart Association, Heart Walk

FCA 5k Registrar Use Only:

Name: Age group: shirt size:

Amount owed: Amount paid: