Share |

Saturday, November 2, 2013 -- Belington, WV
Belington Wellness Center 2nd Annual Turkey Trot (iPO Event Id#: 14871)

Return to the Details Page

RACE CONTACT: Marlana Pennington(Phone) 304-823-1800 , (email)

Fee:$10.00 if PostMarked By Oct 18. $15.00 after. No Refunds.

Make checks out to: Belington Wellness Center

Mail form/payment to:

Belington Wellness Center
70 N. Sturmer Street
Belington, WV 26250

Check One: 5K______ 1 Mile Turkey Wee Trot (Walk)______

Last Name: ____________________________________________________________

First Name: ___________________________________________________________

Address: ______________________________________________________________

City: _________________________________________________________________

State: _________________________ Zip: _________________________

Phone: (__________________)____________________________________

Email: ________________________________________________________

Emergency Contact Name: _______________________________________________

Phone: (__________________)____________________________________

Age: ______ Date of Birth (mm/dd/yy): _____/_____/_____ Gender: __Male __Female

T-Shirt Size (check one): Small___ //Medium___ //Large___ //Extra-Large___ //Extra-Exta Large______(Free to first 30 registered)

WAIVER: I, the undersigned, waive and release myself, my heirs, executors, and administrators, any and all rights and claims for damages, demands, and any other actions whatsoever, which I may have against the Belington Wellness Center, all participating sponsors and supporters of those entities, successors, representatives, and assigns, arising out of my participation in this event. I consider myself adequately trained for the completion of this event. Should I suffer an injury or illness, I authorize officials of this race to use their discretion to have me medically treated and transported to a medical facility and I take full responsibility for this action. no refunds.

Signature _______________________________________________________________________

Date _________________________________________________

Signature of parent/guardian if entrant is under 18:

Signature _______________________________________________________________________

Date _________________________________________________