Please Print Page and Submit to address shown below
6th Annual Sam’s Butterfly Run
(5k Run and 1-Mile Fun Walk)
Sam Mizrahi Memorial Fund
When: 1pm Sunday May 20th 2012
Where: Northern High School Complex
(Check-in near High School Gym Entrance)
Proceeds will be go to the Sam Mizrahi Memorial fund which will award a scholarship to a Northern Senior.
- 5K Run
- Adults - $20
- Students - $10
- 1-Mile Fun Walk - $10
- Tye-Dye Race T-Shirt $15
Please complete form below and mail with check to:
Mizrahi Family, 100 Fairway Dr., Dillsburg Pa, 17019
(checks payable to TFEC-Sam Mizrahi Memorial Fund)
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I wish to enter Sam’s Butterfly Run and Walk. I am medically fit to run or walk the distance involved,
and will not hold the organizers responsible for any injury or loss to my property or person however
caused, before, during or after the event.
Name _______________________Run or Walk
Name _______________________Run or Walk
Name _______________________Run or Walk
Name _______________________Run or Walk
Name _______________________Run or Walk
T-Shirts - $15
S _____
M _____
L _____
XL _____
XXL____
