Sunday, June 16, 2013 -- Morgantown, WV / Hazel-Ruby McQuain River Front Park
RDVIC Father's Day Weekend 5K - MAGP #4
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RACE CONTACT: (e-mail) Sarah Montoro: swmontoro@gmail.com (304-906-5140)
ENTRY FEE . . . $15.00 pre-registration by 06/7/2013 and $20.00 After and on Race Day.
MAIL TO . . .
RDVIC Fathers Day Weekend 5K
c/o RDVIC
P.O. Box 4228
Morgantown, WV 26505
PAYABLE TO . . . RDVIC
NAME____________________________________________________________________
ADDRESS_________________________________________________________________
CITY_________________________________________STATE_______ZIP____________
PHONE (_________________)________________________________
E-MAIL __________________________________________________
AGE ON RACE DAY_________________ BIRTHDATE_______/_______/______________
MALE___ or FEMALE___ RACE SELECTION: 5K RUN___ 5K WALK____
SHIRT SIZE (Please check one): S__ M__ L__ XL__
WAIVER:
In consideration of your acceptance of my application in the RDVIC Fathers Day Weekend 5K Race and Reception, I, for myself and everyone entitled to act on my behalf, waive and release the Rape and Domestic Violence Information Center, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. FONT>
___ I do not plan on attending. However please accept my donation to the RDVIC .
*Entry not valid unless all information herewith is filled out and signed.
_________________________________________________________________________
SIGNATURE (If under 18, Parent or Guardian MUST sign)