Saturday, October 27, 2012 -- Morgantown, WV / Mountaineer Mall, 5000 Greenbag Road, Morgantown, WV 26508
Children's Discovery Museum 2nd Annual Halloween Hustle 5K
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$15 if postmarked by October 06, 2012, $20 therafter and on race day. Day of race registration and race check-in at the CDMWV. T-shirts for all pre-registered 5K participants. T-shirt sales for others.
Mail form and fee to: CDM Halloween Hustle 5K Registration Form , P.O. Box 104, Morgantown, WV 26501
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NAME
GENDER: ____male or ____female // Age on Race Day: _____/_____/_________
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ADDRESS
CITY______________________________________/ STATE______/ ZIP_____________
PHONE (______________________) ___________________________________
E-MAIL____________________________________________________________
T-Shirt Size (check one): ___SMALL / ___MED / ___LG / ___XL (all adult sizes)
I agree to defend, indemnify and hold GP Mountaineer, LLC and/or Children's Discovery Museum of WV their officers, agents, trustees and directors, harmless from all injury, loss, cost, claims or damage to any person or property arising from, related to, or in any way connected to use of the Mountaineer Mall or any conduct undertaken by me thereat. I further waive my rights to assert any claim for loss, cost, injury or damages against GP Mountaineer LLC and/or Children's Discovery Museum of WV their officers, present or arising at any time in the future, arising from, related to, or in any way connected with the use of the Mountaineer Mall or conduct undertaken by me thereat. Any individuals meeting state criteria for business registration are solely responsible for obtaining and maintaining all licenses and permits.
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SIGNATURE (indicates agreement of waiver)
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DATE
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SIGNATURE of Parent or Legal Guardian if under 18
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DATE