Saturday, May 5, 2012 -- Albright, WV
Cheat River Festival 5K ENTRY FORM
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RACE CONTACT: David M. Manthos (e-mail) david.manthos@gmail.com
Early registration $20.00 must be postmarked by April 27 2012, thereafter $25.00
Registration includes admission to the Cheat River Festival for all runners and a free Cheat Fest 5K T-shirt for the first 100 registered runners.
Name: ______________________________________________________________________
Address: ___________________________________________________________________
Town: ______________________________________________________________________
State: _______________ Zip Code: ____________________________________
Phone: (____________________)________________________________________
E-mail: _____________________________________________________________
Date of Birth: ____________________ Age as of 5/5/2012:______________
Male: ___ or Female: ____
Where did you hear about the 5K? ___________________________________________
____________________________________________________________________________
Please Check Tee-Shirt Size: ____Small // ____Medium // ____Large // ____XLarge
WAIVER: In consideration of your acceptance of my application for entrance in the Cheat Fest 5K, I for myself and anyone entitled to act on my behalf, waive and release FOC and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out my participation in this event.
Signature: __________________________________________________________________
Date: ____________________________________
If under 18 years of age:
Entrant's Signature: ________________________________________________________
Parent or Guardian's Signature: _____________________________________________