Saturday, September 15, 2007 -- Dunbar, WV / Wine Cellar Park
33rd Annual Wine Cellar Classic 10K
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- No refund once application has been submitted.
- Make check payable to: Dunbar Recreation Department
- Mail to: Dunbar Recreation Center, 2601 Fairlawn Ave., Dunbar, WV 25064
Sex: ____M _____F Age on 9/15/07_____ T-Shirt Size: ___M ___L ___XL ___XXL
Name:____________________________________________________________________
Address:_________________________________________________________________
City:____________________________________________________________________
State:___________________________ Zip Code:______________________________
Phone#: (_____________)_____________________________________________
please circle one: Run OR Wheelchair
In consideration of your accepting this entry, I hereby, for myself, my heirs, executors, & administration waiver & release any & all rights & claims for damages I may have against Dunbar Parks & Recreation & their representatives for any & all injuries suffered by me in said event. I herefore attest & verify that I am physically fit & sufficiently trained for this 10,000 meter distant run & walk.
Signature:_______________________________________________________________
Parent if under 18_______________________________________________________