Sunday, November 18, 2007 -- Rowlesburg, WV / City Park
K of C Rowlesburg 10K and 5K Run
Return to the Details Page
Entry Fee: Fee is $12.00 if postmarked by November 10th and $15.00 thereafter
Make checks to: Knights of Columbus #9578
Mail To: David G. Pauly, Rt. 1 Box 1146, Kingwood, WV 26537
Name: ___________________________________________________ Male: ___Female____
Address: ________________________________________________ Birth Date: __/___/___
City: ______________________________________________State: ______Zip: __________
Phone: ( )____________________________ Shirt Size: S M L XL Age:______
In consideration of your acceptance of my application for entrance in the Rowlesburg 10-K River Run I, for myself and everyone entitled to act on my behalf, waive and release the Knights of Columbus #9578, the town of Rowlesburg, and all sponsors, for all claims of damage, demands, actions whatever in any manner arising out of my participation in said athletic event. I attest and verify that I have full knowledge of the risks involved in this event and I am physically fit and sufficiently trained to participate in this event.
Signature of Applicant: ___________________________________ Date: ________
Signature of Parent: ______________________________________ Date: ________
(If runner/walker is under age 18)