31st Annual Charleston Distance 15 Mile & 5K Runs

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Saturday, August 30, 2003 -- Charleston, WV
31st Annual Charleston Distance 15 Mile & 5K Runs (iPO Event Id#: 5581)

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Send check or money order to:
Charleston Distance Run Committee
P.O. Box 11595
Charleston, WV 25339

ENTRY FEES - No refunds on any fees!
5K Race
$15 Postmarked by August 20, 2003
$25 Up to August 29, 2003, 9 PM

15 Mile Race
$25 Postmarked between by July 31, 2003
$30 Up to Auguats 20, 2003
$40 Up to August 29, 2003, 9 PM

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Check appropriate one:    15 Mile_____     5K______

_____________________________________________________
LAST NAME             FIRST NAME               MI

_____________________________________________________
STREET OR P.O. BOX

_____________________________________________________
CITY                             STATE      ZIP CODE

(______)________________________ (______)_________________________
         HOME PHONE                            WORK PHONE

AGE ON 8/30/03_____ MALE___ FEMALE___  DATE OF BIRTH:____/____/____

RUNNER'S T-SHIRT SIZE: (Circle one)  S  MED   L    XL    XXL

Optional Souvenir shirt: (Include payment w/Entry Fee)
$10 short sleeve size(s)________  $15 long sleeve size(s)_________

(Circle one): INDIVIDUAL   WHEELCHAIR

If 15 MILE TEAM (Circle one):  
FEMALE OPEN TEAM   MALE OPEN TEAM   MALE MASTERS TEAM   CORPORATE TEAM
   
NAME OF TEAM:_____________________________________________

Team applications must be submitted together, otherwise applicants will be limited to the individual classifications. Maximum of four (4) team members, with only three (3) top members to determine the standings in the Team Division competition.

Predicted time this race:________ Last year's time:________

BEST TIMES 2002-2003:  5K______  10K______  20K______

1/2 MARATHON______  MARATHON______

Runners must pass all checkpoints. Any runner not identified at each checkpoint will be disqualified. Disqualifications will be the decision of the Charleston Distance Run Committee.

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 City of Charleston, the Charleston Regatta Commission, all participating sponsors and supporters of those entities, successors, representatives, and assigns, arising out of my participation in this event, including any and all injuries suffered by me as a result 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.

____________________________________________________ ____/____/____ Signature (Parent or Guardian MUST sign if under 18) DATE ONLY COMPLETED ENTRY FORMS WILL BE ACCEPTED

Affiliates: WVMBA | MAGP | WVMTR | APRRS | WVCXS