Western Montana Chapter                     You will need to print this form and fax (406-543-8088),      
PO Box 430                                                    email (chelsea@bountyrealestate.com)
Missoula, MT 59806                                      or mail to MDF, PO Box 430, Missoula, MT  59806
                                                                        To register by phone, call 406-721-7171
 
2014 Run & Shoot Registration
 
Please mark the run(s) for which you are registering:
 
_______ 5 K                                     Fun Run    _____ 8:15                   _____ 9:15
                                                                                _____ 8:30                    _____  9:30
                                                                                _____ 8:45                    _____  9:45  
                                                                                _____ 9:00                    _____10:00  
 
Name _________________________________          T-Shirt Size Adult _______ Youth ______
 
Address _______________________________         ________________                        ____     _______
                 Street or PO                                                        City                                         State    Zip
Email (so we can confirm your registration)   ______________________________________
 
Fee:  $ 20.00 per runner ages 10-90                                                                  $___________
---- under 10 or over 90 are free
 
Family sign up:       Additional Name                             T-Shirt Size              Additional Fees
 
                                    ______________________           ____________         _____________
                                   
                                    ______________________           ____________         _____________
 
                                    ______________________           ____________         _____________
 
                                    ______________________           ____________         _____________
 
                                    ______________________           ____________         _____________
 
                                    ______________________           ____________         _____________
 
                                                              Total Fee                  $ ____________
 
Total Paid by:   Check __________       Cash ___________
 
      Credit Card #__________________________       Exp. Date _______ ID(from back)__ __ __
 
Run & Shoot is a fundraiser for the Western Montana Chapter of the Mule Deer Foundation
 


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