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Saturday, September 16, 2006 -- Dunbar, WV
32nd Annual Wine Cellar Classic 10K
(iPO Event Id#: 7725)
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No refund once application has been submitted
Check payable to: Dunbar Recreation Department
Mail to: Dunbar Recreation Center 2601 Fairlawn Ave. Dunbar, WV 25064
Name________________________________________________Sex______Age_______
Address________________________________________City_____________________
State_________Zip Code____________________ T-Shirt M L XL XXL / LS SS
Phone # ________________________________________
(please circle one) Run Wheelchair
In consideration of your accepting this entry, I hereby, for myself, my heirs, executors, & administration waiver & release any & all rights & claims for damages I may have against Dunbar Parks & Recreation & their representatives for any & all injuries suffered by me in said event. I herefore attest & verify that I am physically fit & sufficiently trained for this 10,000 meter distant run & walk.
Signature______________________________________________________________
Parent if under 18_____________________________________________________
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