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Saturday, June 19, 2010 -- Charleston, WV
Run for Your Life 5-Mile Run ENTRY FORM (iPO Event Id#: 12851)

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Registration is $15 if postmarked by 6/12 and $20 after 6/12.

Make checks payable to CAMC Foundation. Send checks and entry forms to:

CAMC Foundation
3412 Staunton Ave. S.E.
Charleston, WV 25304

NAME ____________________________________________________________________________

ADDRESS _________________________________________________________________________

CITY/STATE/ZIP __________________________________________________________________

E-MAIL __________________________________________________________________________

MALE / FEMALE (circle one) // AGE ON RACE DAY (6/19/10) ________

RELEASE: As consideration for acceptance of this entry, I hereby release for myself, my heirs, and assigns, any and all claims for injuries and damages of any kind which may occur as a result of my participation in this race and which I might have against the Smoke on the Water Chili Cook-Off, its organizing committee, this race and its organizing committee, any and all sponsors of the Smoke on the Water Chili Cook-Off and this race, the City of Charleston, and/or any other organization, business, or individual, associated with the Smoke on the Water Chili Cook-Off or this race. Additionally, I agree to release any photographs of myself taken during the race for promotional purpose.

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SIGNATURE

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DATE

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Parent or guardian signature (required for minors)