Sunday, November 22, 2009 -- Rowlesburg, WV / Starts at Rowlesburg Park
K of C Rowlesburg 10K Run / 5K Run and Walk
ENTRY FORM
Return to the Details Page
Entry Fee: Fee is $15.00 if postmarked by November 14th and $20.00 thereafter
Make checks to: Make checks to CPMS Cross Country
Mail To: David G. Pauly, 603 Borgman Road, Kingwood, WV 26537
Name: ___________________________________________________________ Male: ___ Female____
Address: ________________________________________________ Birth Date: ____/____/______
City: ______________________________________________State: ________Zip: ______________
Phone: ( )_________________________ Shirt Size: S M L XL Age:______
Choose Race: 10K____ -- OR -- 5K_____
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)