Saturday, August 14, 2010 -- Elkins, WV
Kenneth Cunningham Memorial Cross Country Race
ENTRY FORM
5K XC Run, 2M Trail Walk, 1/2M XC Kids Run, 400 Meter Kids Run
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- 400 meter run is free
- $8.00 for Trail walk and 1/2 mile Cross-Country Run
- $12.00 for 5-K run before Monday, August 9, 2010
- $15.00 after August 9th and day of the race
Checks payable to: Elkins Middle School Cross-Country or EMS Cross-Country
Mail to:
Todd Price, Ken's 5-K X-C Run
Rt. 3, 213 Hickory Drive
Elkins, West Virginia 26241
NAME: _______________________________________________________________________
AGE on 08/14/10 ___________ SEX: F or M
ADDRESS:_____________________________________________________________________
CITY:______________________________________ STATE:_________ ZIP:_____________
PHONE:(____________________)_____________________________________
Shirt size: _____Youth Med _____Youth Large
(Adult) _____Med. _____Large ______X-Large ______XX-Large
PLEASE CHECK: TEAM EVENT____/ 2-MILE WALK_____/ 5-K RUN_____/ 1/2 MILE X-C RUN______/ 400 METER RUN_____/
Release Waiver: I, the undersigned, in consideration of my entry in the Kenneth Cunningham 5-K Cross-Country Run, do certify that I am physically fit and suitably trained to participate in said event. I agree to be bound by all rules of the race and decisions of the officials. I hereby forever release and discharge the organization and sponsors holding this event, its agents, representatives, successors, and assigns from any and all claims, courses of action, and suits which shall or may have arisen as a result of my participation in said event.
_____________________________________________________________ Date:______________ Signature of the Runner _____________________________________________________________ Date:______________ Signature of Parent or Guardian if applicant under 18 years of age.