| Organization Name: | ______________________________ | ||
| Contact Person: | ______________________________ | ||
| Address: | ______________________________ | ||
| City: | __________ | State: __________ | Zip: __________ |
| Day Phone: | __________ | Fax:__________ | |
| Evening Phone: | __________ | E-mail: __________ | |
| Entry Fees: | _______________ | 8+ | @ | $64 = | _______________ |
| _______________ | 4X/+ | @ | $40 = | _______________ | |
| _______________ | 2X/- | @ | $26 = | _______________ | |
| _______________ | 1X | @ | $17 = | _______________ | |
| Total Fees = | _______________ |
| Are you bringing a trailer? | Yes | No |
| Are you car-topping? | Yes | No |
Kimberly Hart, Registrar 1201 Melville Square #412 Richmond, CA 94804
The Lake Merritt Sprints Registration Packet is available
on the LMRC Web Site at http://www.dsp.com/mbcooper/lmrc/
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