Saturday, June 18, 2011 -- Charleston, WV
Run for Your Life 5-Mile Run ENTRY FORM
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RACE CONTACT: Jim Harlan (phone) 304-357-4615
Registration is $15 if postmarked by 6/11 and $20 after 6/11. Late registration is 7 to 8 a.m. on race day.
Make checks payable to CAMC Foundation.
Send checks and entry forms to: CAMC Foundation, 3412 Staunton Ave. S.E., Charleston, WV 25304
NAME ____________________________________________________________________________
ADDRESS _________________________________________________________________________
CITY/STATE/ZIP __________________________________________________________________
E-MAIL __________________________________________________________________________
MALE _____ / FEMALE _____ (check one) // AGE ON RACE DAY (6/18/11) ___________
RELEASE: As consideration for acceptance of this entry, I hereby release for myself, my heirs, and assigns, any and all claims for injuries and damages of any kind which may occur as a result of my participation in this race and which I might have against the Smoke on the Water Chili Cook-Off, its organizing committee, this race and its organizing committee, any and all sponsors of the Smoke on the Water Chili Cook-Off and this race, the City of Charleston, and/or any other organization, business, or individual, associated with the Smoke on the Water Chili Cook-Off or this race. Additionally, I agree to release any photographs of myself taken during the race for promotional purpose.
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SIGNATURE
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DATE
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Parent or guardian signature (required for minors)