Sunday, April 22, 2007 -- Hopwood, PA / Route 40
Mount Summit Challenge 3.5 Mile Run and Walk (iPO Event Id#: 10061) - Return to the Details Page

Race Fee: Registration by April 1, 2007 is $20; afterwards and race day $25
*Additional $2 for XXL * $5 off if 18 and under

Please PRINT CLEARLY (Incomplete applications will NOT be processed!)

Name________________________________ Age____ Date of Birth________

Address___________________________________________________________

City_________________________________ State______ Zip_____________

Phone_________________________ Sex: Female Male

PLEASE CIRCLE ONE EVENT: WALKER ---or--- RUNNER

PLEASE CIRCLE ONE IF RUNNER, What Division?
Open/Age Group --- CRUISER --- CLYDESDALE

Shirt size PLEASE CIRCLE ONE S -- M -- L -- XL -- XXL(+$2.00)

In consideration of my entry being accepted in the Mt. Summit Challenge race, I, intending to be legally bound, do hereby, for myself, my heirs, executors, and assigns, waiver, release and forever discharge any and all rights and claims for damages that I may have or which may hereafter accrue to me against the Mt. Summit Challenge, Fayette Striders Running Club, SERJ Racing Services, PennDOT and all sponsors. I understand the difficulty of this event and agree that I am in good physical condition.

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Athlete Signature Date

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Signature of Parent/ Guardian if Athlete is under 18 yrs of age