Sunday, October 3, 2010 -- Elkins, WV
Mountain State Forest Festival 10K Run/5K Walk/Kids Race ENTRY FORM
RACE CONTACT: Jim Severino (phone) 304-637-5601 (e-mail) jseverino2@verizon.net
Make checks payable to Mountain State Forest Festival // Cost $15.00
Kids Race is FREE to ages 10 and under, but please fill out an entry form for your child.
Please mail Pre-Registration before September 24, 2010 to:
Jim Severino
106 Edgewood Lane
Elkins, WV 26241
Name:_____________________________________________________________
Address:__________________________________________________________
__________________________________________________________________
Choose One:
Run _________ OR Walk _________ // Male _________ OR Female _________
Age on 10/03/2010_______________
Check Shirt Size:
Adult/ S____ M____ L____ XL____ XXL____ OR Youth/ S____ M____ L____
Waiver and Release: I agree to assume all risks of injury, damages, or liability associated with participation in the 2010 Forest Festival 10KM Run/5KM Walk. I understand that there are certain risks inherent in participating in athletic sporting events including, but not limited to, personal injury and property damage. I further agree to hold the Mountain State Forest Festival, their agents, employees, and volunteers harmless from and waive all liability, actions, causes of actions, claims, expenses, and damages on account of injury caused by their own negligence or otherwise. I further state that I have carefully read the foregoing release and know the contents thereof and sign this release of my own free act.
____________________________________________________________________
Signature (Parent's signature if under 18)
__________________________________________
Date
____ :Check if you are a student athlete and are not eligible to accept cash prizes.