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Sunday, December 6, 2009 -- Morgantown, WV / Krepps Park, Suncrest
Back Bay Snowflake Sprint 5K (iPO Event Id#: 12405)

Road Runners Logo

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

Mail entry Forms to:
W.VA. Track Club
P.O. Box 4159
Morgantown, WV 26504

PLEASE PRINT - (APPLICATION MUST BE SIGNED)

NAME:_____________________________________________________

ADDRESS:__________________________________________________

CITY:_______________________________STATE:____ZIP:________

PHONE:____________________________________________________

AGE ON 12/6/09:______  MALE:______ FEMALE:_______ 

Date of Birth:________________ 5K RUN___  5K WALK___  KID'S RUN___

T-SHIRT SIZE:  ADULT: S__ M__ L__ XL__  CHILD: S__ M__ L__

WAIVER:
In consideration of your acceptance of my application for entrance in
the Snowflake Sprint 5K Run/Walk or Flurry Fun Run for Kids, I, for
myself and anyone entitled to act on my behalf, waive and release the
Morgantown Roadrunners/West Virginia Track Club, the Road Runners Club
of America and all sponsors, their representatives and successors from
all claims or liabilities of any kind arising out of my or my child's
participation in this event.
         
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Entrant's Signature

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Parent or guardian's Signature if under 18 years old