Saturday, May 15, 2010 -- Charleston, WV / Kanawha State Forest
Dirty Dog 15K Trail Run ENTRY FORM
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Register/Fee: *T-shirt guaranteed to first 150 registrants.
Pre-registration is $20 if postmarked by MAY 8, 2010 and $25 thereafter.
Race day registration will be from 7:30 to 8:30 am.
Checks payable to:
WVMTR (WEST VIRGINIA MOUNTAIN TRAIL RUNNERS)
Mail entry forms/checks to:
Daniel Todd / DIRTY DOG 15K TRAIL RUN, 609 Albert Street, Charleston, WV 25302
Female_____ Male_____ Age on May 15, 2010_______ NAME:____________________________________________________________________________ ADDRESS:_________________________________________________________________________ CITY:____________________________________ STATE:__________ ZIP CODE______________ PHONE:_________________________ E-MAIL:__________________________________________ Is your dog participating? Yes_____ N/A_____ Dog's Name:_________________________ * Technical Trail Runner Tee SIZE: S______ M______ L_____ XL_____
WAIVER: For and in consideration of my participation in the DIRTY DOG 15K TRAIL RUN in Charleston, WV, I, the undersigned, release forever the sponsors, the program, its members, volunteers, co-sponsors, landowners, race organizers, race directors, other participants and all those associated with the DIRTY DOG 15K TRAIL RUN from any claim for harm, injury or loss that occurs to me or my child/ward or anyone on his/her behalf as a result of participation in this event. I therefore attest and verify that I am physically fit and have sufficiently trained for this event and am aware of the potential dangers.
SIGNATURE:____________________________________________________________________ (PARENT/GUARDIAN MUST SIGN IF UNDER THE AGE OF 18)