Sunday, March 29, 2009 -- Morgantown, WV / Coopers Rock State Forest
Cooper's Rock 10K Run & 5K Walk (iPO Event Id#: 11890)

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Please make checks payable to: W.Va. Track Club

Mail to: W.Va. Track Club at PO Box 4159, Morgantown, WV 26504

Please Print Legibly- Enter All Applicable Information & Sign

                                        

NAME________________________________________________   MALE ___  FEMALE ___

ADDRESS_____________________________________________   Birthdate____/____/____
                                                       mm / dd /yyyy   
       _____________________________________________   T-SHIRT M__ L__ XL__

PHONE  _____________________________________________
                                              
EVENT    10K Run ____  5K Walk ____

Waiver - Must Sign: In consideration of your acceptance of my application for entrance in the Cooper's Rock 10K Run & 5K Walk, I, for myself and anyone entitled to act on my behalf, waive and release the Morgantown Roadrunners/West Virginia Track Club, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event.

_________________________________________________________________________
Signature of Entrant (Required)

_________________________________________________________________________
Signature of Guardian (if under 18)