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Saturday, May 10, 2008 -- Charleston, WV / Cross Lanes
Poca River 15K Road Race
(iPO Event Id#: 10839)
--- Return to the Details Page
Make Checks Payable to: KVRRC
Send Entry Form to:
Kanawha Valley Road Runners Club 19 Riverside Drive, South Charleston, WV 25303
POCA RIVER 15K ENTRY FORM
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NAME
_________________________ ____________________
AGE ON MAY 10, 2008 MALE OR FEMALE
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ADDRESS
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CITY STATE ZIP CODE
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TELEPHONE NUMBER
CIRCLE SHIRT SIZE (circle one): Medium Large XLarge
WAIVER: (MUST BE SIGNED OR ENTRY WILL NOT BE ACCEPTED)
In consideration of the Poca River 15K Road Race. For myself, my heirs, executors, and administrators, I hereby release any and all runners, the sponsors, or the county or state in which this race is contested. I attest and verify to the best of my knowledge, my physical condition and fitness are adequate for me to safely compete, and no physician or qualified individual has advised me against competing in the Poca River 15K.
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SIGNATURE
(Parent/Guardian MUST sign if runner is under 18 years of age)
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