Saturday, September 11, 2010 -- Sutton, WV
Mountain Lakes Festival 5K "That Dam Race" ENTRY FORM
CONTACT: Braxton CVB, Phone: 304-764-6533, E-mail: info@braxtonwv.org
Entry Fee: $15.00
Make Checks payable to: Braxton Co. Visitors Bureau
Mail to:
Braxton Co. Visitors Bureau
245 Skidmore Lane
Sutton, WV 26601
PLEASE PRINT
Name:________________________________________________________________________________
Address:_____________________________________________________________________________
City/State/Zip:______________________________________________________________________
Phone:(______________)________________________________________
E-mail:_______________________________________________________
Age: ____ // Gender: ___Male ___Female // Shirt Size*: S___ M___ L___ XL___
*(first 100 paid entries will receive shirts)
Waiver: In consideration of acceptance of this entry to the Mountain Lakes 5K Run and Walk, I waive all claims for myself, my heirs and assigns against the race sponsors, promoters, or officials due to injury or illness which may result from my participation. I attest and verify that I have full knowledge of the risk involved in these events. I am physically fit, and sufficiently trained to participate. I have read the above statement, I understand it, and my signature confirms its full acceptance.
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Signature
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Date