Saturday, April 28, 2012 -- Morgantown, WV / Hazel Ruby McQuain Amphitheatre
Earth Day Challenge ENTRY FORM
10K run, 5K run/walk, Kids Fun Run
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RACE CONTACT: Laura Layva (phone) 304-216-1981
$20 for applications postmarked by April 13, 2012 // $25 after April 13th.
All fees are non-refundable. T-shirts are guaranteed to pre-registered runners ONLY!
Checks payable to: Mon. County SWA // Mail or Deliver to: BOPARC, PO Box 590, Morgantown, WV 26507
Name: ______________________________________________________________________
Address: ___________________________________________________________________
____________________________________________________________________________
Phone #: (_______________________) _____________________________________
Email: _________________________________________________________________
Age as of 4/28/12 ________ // Male____ Female____
In which event will you be participating? CHECK ONE
10K____ // 5K Run____ // 5K Walk____ // 10 & under Fun Run____
T-SHIRT SIZE NONE____ // S____ // M____ // L____ // XL____ // XXL____
RELEASE STATEMENT: In consideration of acceptance of this entry, I waive any and all claims for damages that may result from my participation, or from the participation of the minor that I am signing for in the 2012 Earth Day Challenge. 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.
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Signature of Participant (Parent or Guardian MUST sign if under 18 yrs of age)