Saturday, April 17, 2010 -- Morgantown, WV
Earth Day 5K ENTRY FORM
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- $15.00 // Applications received by Monday, April 10, 2010
- $20.00 // After April 12th and on race day
- All fees are non-refundable
Make checks payable to: Mon. County Solid Waste Authority/ Earth Day 5K
Mail to: BOPARC, P.O. Box 590, Morgantown, WV 26507-0590
Name:____________________________________________ Phone: (__________)_____________________
Address:__________________________________________________________________________________
City/State/Zip:___________________________________________________________________________
Gender: M____ F____ // Date of Birth: _____/_____/_________ Age on 4/17/10:______
Email:_____________________________________________________
Choose the event you will participate in: 5K Run___ // 5K Walk___ // Children's Fun Run___
T-Shirt Size: Small____ Medium____ Large____ XL____
Release Statement: In consideration of acceptance of this entry, I waive any and all claims for damages which may result from my participation, or from the participation of the minor that I am signing for in the 2010 Earth Day 5K. Any and all claims are waived for myself, heirs, and assigns. The sponsors and their agents or representatives will assume no obligation for injuries or damages that I may incur.
Signature of Participant:____________________________________________________________
Date:___________________________
Signature of Parent/Guardian:_____________________________________________________
Date:___________________________