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Saturday, April 21, 2012 -- Elkins, WV
Catholic Charities Race for Hope Half Marathon 5K Run/Walk (iPO Event Id#: 13803)

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RACE CONTACT: Cindy Hammer (phone) 304-636-4875 (e-mail)

Please Check One: All pre-registered runners are guaranteed a T-shirt!

    ____ Half Marathon BY April 10th = $25.00

    ____ Half Marathon AFTER April 10th = $35.00

    ____ 5K Run/Walk BY April 10th = $15.00

    ____ 5K Run/Walk AFTER April 10th = $20.00

    ____ Kids under 12 years of age, Please Register = Free

Method of Payment, check one: Check_____ or Cash_____

Make checks payable/send to: Catholic Charities WVa, PO Box 2764, Elkins,WV 26241

Name _________________________________________________________________________________

Address ______________________________________________________________________________

City, State, Zip _____________________________________________________________________

Phone (____________) __________________________ // Gender: Male_____ OR Female______

Age on April 21, 2012 ________ // Birth Date _______/_______/___________________

    Shirt Size (ADULT): S____ M____ L____ XL____ XXL____

    Shirt Size (YOUTH): S____ M____ L____ XL____

WAIVER: By checking the box below, you agree, warrant and covenant as follows: In submitting this entry, I, intending to be legally bound for myself, my heirs, executors and administration, waive, release and forever discharge any and all rights and claims which I may hereafter accrue against Catholic Charities WVa, the Diocese of Wheeling-Charleston, any event sponsor, event volunteer, event staff, and their officers, directors, agents, successors, and/or assigns for any injuries suffered by me at this event while raveling to and from the event or while participating in it. I attest and verify that I am physically fit and sufficiently trained for the competition of this event. I understand that I may be photographed and agree to allow my photo, video or film likeness to be used for legitimate purpose by the aforementioned parties.

_____Please check and sign below to indicate that you agree to the above.



SIGNATURE (Parent's signature if under 18 years old)