Merrill King Registration Form

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Register for the Merrill King's Fit 4 Fall 5K and 1 Mile Fun Run!

Transcript of Merrill King Registration Form

Page 1: Merrill King Registration Form

Merrill King’s Fit 4 Fall 5K & 1-Mile Fun Run

Merrill King’s Fit 4 Fall 5K and 1 Mile Fun Run will be held in honor of Merrill King, a victim of childhood cancer. Participants can run

the 5K or take their families for a fun jog in the 1 Mile Fun Run.

Saturday, August 14th Registration begins at 6AM, Race will start at 8 AM

Where: Roswell High School - 11595 King Road, Roswell, GA 30075

Cost: $20 donation to run, $25 (After August 12)

About Merrill: Active in many sports, Merrill King loved to run and play soccer.

She was diagnosed with Leukemia in April of 2004, but fought the disease for four years before she relapsed in 2008. Sadly, Merrill passed away in February 2010,

but her legacy lives on.

Merrill King’s Fit 4 Fall 5K & Fun Run Registration Form

Name: ___________________________ Birthdate: _____________ Gender: ________

Address: _________________________________________________________________

City, State, Zip: ___________________________________________________________

Email Address: _____________________________ Phone: __________________

Race: □ 5K □ Fun Run Phantom Runner?: □ Y □ N

T-shirt Size (circle one): YS YM YL YXL S M L XL XXL

Payment Information: I wish to pay by check or cash I wish to pay by credit card (See below)

Name on Card Billing Phone Number

Billing Address Billing City, State, Zip

Credit Card Number Expiration Date CVV Code

Name (Please Print) Signature

Note: Please make checks payable to Rally Foundation

Memo: Merrill King 5K (Required) Mail your registration to: Rally Foundation, 5775 Glenridge Drive, Building C, Suite 120,

Sandy Springs, GA 30328. Questions? Call Donna Cobb (404) 840-6798