Saturday, April 17, 2010 -- Danese, WV / Babcock State Park
Babcock Gristmill Grinder ENTRY FORM
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Half Marathon Run Fee // $25 if postmarked by April 8th, 2010 and $30 thereafter
Fun Walk (3 miles) Fee // $15 if postmarked by April 8th, 2010 and $20 thereafter.
Please make checks payable to: Mountain Air Productions
Mail forms to: Donnie Hudspeth /Mountain Air Productions, P O Box 102, Hico, WV 25854
NAME:_________________________________________________________________________ ADDRESS:_____________________________________________________________________ CITY:____________________________________ STATE:__________ ZIP CODE______________ PHONE:(___________)__________________ E-MAIL:____________________________________ Female______ Male______ // Age_______ Shirt Size: S_____M______ L_____ XL_____
WAIVER: For and in consideration of my participation in the Babcock Gristmill Grinder Half-Marathon Trail Run and 3 Mile Fun Walk, I, the undersigned, release forever the sponsors, the program, its members, volunteers, co-sponsors, landowners, race organizers, race directors, other participants and all those associated with the Babcock Gristmill Grinder Half-Marathon Trail Run and 3 Mile Fun Walk from any claim for harm, injury or loss that occurs to me or my child/ward or anyone on his/her behalf as a result of participation in this event. I therefore attest and verify that I am physically fit and have sufficiently trained for this event and am aware of the potential dangers.
SIGNATURE:_______________________________________________________________
(PARENT/GUARDIAN MUST SIGN IF UNDER 18)