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Saturday, July 27, 2013 -- Beckley, WV
"It's a Hospice Thing" 5K run and Memorial Walk (iPO Event Id#: 14712)

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RACE CONTACT: (e-mail) Josh Jones: (304-255-6404)

ENTRY FEE . . . $20.00 pre-registration by 07/2/2013. $25 From 07/7/2013-July 26. $35 onsite registration.

MAIL TO . . .
Hospice of Southern WV
ATTN: 5K Run and Memorial Walk
PO Box 1472
Beckley, WV 25801

PAYABLE TO . . . Hospice of Southern WV.




PHONE (_________________)________________________________

E-MAIL __________________________________________________

AGE ON RACE DAY_________________ BIRTHDATE_______/_______/______________


SHIRT SIZE (Please check one): S___ M___ L___ XL___ XXL___

WAIVER: I know that participating in this walk/run is potentially hazardous. I should not enter unless I am medically able and properly trained. I also assume any and all risks associated with this event including but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity, and the condition of the roads and traffic, all such risks being known and appreciated by me. Knowing these facts, and in consideration of accepting my entry, I hereby, for myself, my heirs, executors, administrators, or anyone else who might claim on my behalf, covenant not to sue, and waive, release and discharge Hospice of Southern West Virginia, and/or any agents authorized by them for any purpose. This release and waiver extends to all claims of every kind or nature, whatsoever, foreseen or unforeseen, known or unknown.FONT>

SIGNATURE  (If under 18, Parent or Guardian MUST sign)