Saturday, July 11, 2009 -- Oceana, WV
Oceana Heritage Festival Run & Walk - Coal Heritage Classic #2
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Make check or money order payable to: Wyoming County CVB
Mail to: The Coal Heritage Highway Authority, Mullens Dogwood Race, PO BOX 5176, Beckley, WV 25801
Pre-registration is $12 and day of registration is $17 for each event.
(Please print neatly)
NAME
(first)__________________________________________________________________
(last)__________________________________________________________________
DATE OF BIRTH _______/________/______________ // AGE on race day________
ADDRESS
(street)________________________________________________________________
(county)________________________________________________________________
(city)__________________________________________________________________
(state)_________________________________________________________________
(zip code)_________________________________
PHONE (______________)___________________________________________
E-MAIL____________________________________________________________
T-SHIRT SIZE (check one): S____ M____ L____ XL____ XXL____
WAIVER All participants in the Coal Heritage Classic Series: Mullens Dogwood Race and related events are required to assume all risk of participation in the race by signing this general release agreement. The participant represents and warrants that he/she is in good physical condition and is able to safely participate in the race. Participant is aware of the risks and hazards involved with 5k run/walks. Participants consent to use their name and photo for media purposes. Registration fee is nonrefundable.
________________________________________________________________________
Signature of Participant // Date
________________________________________________________________________
Or parent if participant is under 18