Saturday, September 11, 2010 -- Morgantown, WV
Generation Morgantown Canine Classic 5K Run & Walk ENTRY FORM
CONTACT: Rick Remish (IMAGINE West Virginia), Phone: 304-282-4022, E-mail: rick.remish@imaginewestvirginia.com
Make Checks payable to: GMCT-Generation Morgantown Fund
Mail Form and Fee to:
Canine Classic 5k c/o GMCT
P.O. Box 409
Morgantown, WV 26507
BEFORE August 25th: $15.00 per adult, $10.00 per child (under 16), Dogs run FREE
AFTER August 25th through race day: $20.00 per adult, $15.00 per child (under 16), Dogs run FREE
Name: _______________________________________________________________________________
Gender:___________________ Age:(as of 9/11/2010)__________ Date:_______________________
Phone: (_________________)__________________________________
E-mail: ________________________________________________
Adult T-Shirt Size (circle one): S_____ M_____ L_____ XL_____
Address(Street/City):________________________________________________________________
(State/Zip):__________________________________________________________________________
Check one: Runner:__________ Walker:________ Amount Enclosed:________________________
In case of emergency, Please notify:
Name: _______________________________________________________________________________
Relationship: _______________________________________________
Phone: (_________________)__________________________________
In consideration of acceptance of this entry, I waive any and all claims for injuries or damages which may result from my participation, or from the participation of the minor or pet that I am signing for in the Generation Morgantown Canine Classic. Any and all claims are waived for myself, heirs and assigns. Generation Morgantown, the sponsors and their agents or representatives will assume no obligation for injuries or damages that may be incurred.
_____________________________________________________________________________________
Pet's Name
_____________________________________________________________________________________
Owner's Signature (or signature of non-dog owner)
_____________________________________________________________________________________
* Signature of Parent or Guardian
*Parent's or Guardian's signature required if contestant is under 18 years of age.