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Online Entry Confirmation Receipt:
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Confirmation Number:
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21179-41513-57917-10242009-194214
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Event:
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Tom Caruso Run
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Race/ Category:
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5K Run/Walk
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Name:
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Mikel Black
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Event Day Age:
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35
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Gender:
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F
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Registration Date:
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10/24/2009
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Registration Method:
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ONLINE
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Registration Status:
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REGISTERED
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Bib:
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Registration :
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Registration (Qty: 1)
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Apparel :
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Event Shirt (Qty: 1)
Size: XL
Style: Short-Sleeved
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Authorization Letter
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I, Mikel Black, hereby authorize __________________________________ to act on my behalf to pick up my packet for the Tom Caruso Run '09. Any and all acts carried out on my behalf shall have the same affect as acts of my own.
____________________________
Name: Mikel Black
Date: 9/9/10
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