Sunday, April 22, 2012 -- Beckley, WV
Earth Day,'It's Your World'
Go for the Green 10K Race ENTRY FORM
Return to the Details Page
RACE CONTACT: Sherrie A. Hunter (phone) 304-255-9335/304-573-5195
Fee: $20.00 for each racer if registered before April 22th, $25.00 On Race Day
ALL PRE-REGISTERED ENTRIES RECEIVED BY April 13th - Are guaranteed a t-shirt
Payable to:The Raleigh County Solid Waste Authority
Mail To:
Raleigh County Solid Waste Authority
Attention: Sherrie A. Hunter
200 Fernandez Drive
Beckley, WV 25801
NAME: Last__________________________________ First___________________________________
ADDRESS:_______________________________________________________________________________
CITY, STATE, ZIP_______________________________________________________________________
PHONE:_________________________________________________________________________________
Email:________________________________________________________
Age:___________ Male_______ OR Female_____ // SHIRT SIZE: ___M ___L ___XL ___XXL
WAIVER: THIS FORM MUST BE SIGNED BY ALL 10K Run Participants
I understand that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running in this event, including, but not limited to, those known and unknown by me. Having read this waiver and understanding these facts and in consideration of your accepting my entry, I, for myself, and anyone entitled to act on my behalf, waive and release the Raleigh County Solid Waste Authority, Earth Day 10K Run Committee, City of Beckley, the YMCA of Southern West Virginia, Sams Club, Childrens Miracle Network, all organizers, all volunteers, all sponsors, their representatives, and successors from all claims or liabilities of any kind arising out my participation in this event.
SIGNATURE REQUIRED:________________________________________________________________
PARENTS MUST ALSO SIGN IF RUNNER IS UNDER 18 YEARS OF AGE
Parent/Legal Guardian:________________________________________________________________