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Sunday, May 29, 2005 -- Point Marion, PA
Albert Gallatin Regatta 5K (MAGP #5)
(iPO Event Id#: 6756)
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ENTRY FEE: $14.00 (Postmarked by May 19) - After this date & on site (shirt not guaranteed)frr is $17.00
Make check payable to: Albert Gallatin 5K
Mail To: Albert Gallatia 5K, P.O. Box 1496, Morgantown, WV 26507
NAME:____________________________________________________________________
ADDRESS:_________________________________________________________________
CITY:________________________________________ STATE:_____ ZIP:____________
CHECK ONLY ONE: 5K RUN______ 5K WALK______
T-Shirt Size - M____L____XL____ Male_____ Female_____
DATE OF BIRTH __________/ __________/ ___________ (month/day/year)
Race Waiver - Must be signed!
In consideration of your acceptance of my application for the entrance in the Albert Gallatin River Regatta 5K Run & 5K Walk, I, for myself and anyone entitled to act on my behalf, waive and release the Albert Gallatin Regatta, the Race Director, and all sponsors, volunteers, officials, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event.
______________________________________________________
Signature (required)
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Parent or Guardian MUST SIGN if under 18
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Date
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