Sunday, October 19, 2008 -- Philippi, WV / AB College Campus
Alderson-Broaddus PA 5K Run/Walk
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Mail forms and payment to: Brittney Stephen, 310 N Walnut St., Philippi, WV 26416
- Make checks payable to: HU C. MYERS SOCIETY
- Pre-registration fee: $12 (if received by October 3, 2008)
- Registration fee day of race $15
Name _____________________________________________________ Age (as of Oct. 19 2008)_____
Address ________________________________________________________________________________
State/City/Zip__________________________________________________________________________
Phone # (_______________)__________________________________
Circle One: Male OR Female // Circle One: Run OR Walk
Check adult T-shirt size (choose one): Small _____ Medium_____ Large _____ XL _____
Waiver + MUST SIGN:
In consideration of the acceptance of my entry in the A-B PA 5K Run/Walk, I certify I am physically fit to participate and I do agree to be bound by all the rules of the race and all decisions of the official judges. I assume all risk associated with running this race, including, but not limited to falls, contact with other runners, the effects of weather, traffic and the condition of the road; all such risks being known and appreciated by me. I do hereby forever release and discharge Alderson-Broaddus College, Hu C. Myers Society, all race officials, all volunteer workers, and any other race sponsors and their representatives, successors, and assigns of all foregoing from any and all claims courses of action or suits, which I or my heirs or assigns, shall or may have arising from or as a result of my participation in the said race to be held on October 19, 2008. I hereby consent to use of my name and/or photograph in connection with publicity about the race.
_________________________________________________________________________________
Signature of runner/walker OR parent or legal guardian (if less than 18)
Date __________________________________