Sunday, November 23, 2008 -- Rowlesburg, WV / City Park
K of C Rowlesburg 10K and 5K Run - MAGP Endurance #9
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Entry Fee: Fee is $15.00 if postmarked by November 15th and $20.00 thereafter
Make checks to: CPMS Cross Country
Mail To: David G. Pauly, Rt. 1 Box 1146, Kingwood, WV 26537
Name: ___________________________________________________ Male: ___Female____
Address: ________________________________________________ Birth Date: __/___/___
City: ______________________________________________State: ______Zip: __________
Phone: ( )_________________________ Shirt Size: S M L XL Age:______
Choose Race: _______10-K --- OR --- ______ 5-K
In consideration of your acceptance of my application for entrance in the Rowlesburg 5 & 10-K River Run I, for myself and everyone entitled to act on my behalf, waive and release the Knights of Columbus #9578, the town of Rowlesburg, Central Preston Middle School, and all sponsors, for all claims of damage, demands, actions whatever in any manner arising out of my participation in said athletic event. I attest and verify that I have full knowledge of the risks involved in this event and I am physically fit and sufficiently trained to participate in this event.
Signature of Applicant: ___________________________________ Date: ________
Signature of Parent: ______________________________________ Date: ________
(If under age 18)