Saturday, June 12, 2010 -- Fairmont, WV / Marion County Adult Ed Center
Run to Read Races ENTRY FORM
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Please make all checks payable to: Literacy Volunteers of Marion County
Mail check and pre-registration form to: LV of Marion County, 601 Locust Avenue, Fairmont WV 26554
____ 5K Run ------- $15 ($20 after 6/7/10)
____ 5K Walk ------ $15 ($20 after 6/7/10)
____ 15K Run ------ $15 ($20 after 6/7/10)
____ 15K + 5K*---- $20 ($25 after 6/7/10)
____ Fun Run/Walk $10 ($15 after 6/7/10)
*** Double-entered runners: Your entry fee covers timing in 2 events, up to 2 awards and 1 shirt
NAME ___________________________________________________________________
ADDRESS_________________________________________________________________
CITY____________________________________________________________________
STATE, ZIP _____________________________________________________________
PHONE (________________)______________________________________
AGE ____(on 6/12/10) BIRTHDATE _______________ // MALE______ FEMALE______
EMAIL (OPTIONAL)___________________________________
SHIRT SIZE: Youth M__ Adult S___ M___ L___ XL___
Tank top (Adult sizes only)_____ or Tee shirt______
WAIVER: I waive for myself, my heirs, and assigns, all claims for damages which I might have against the race, its sponsors, or any other organization, business, or individual as a result of any and all injuries which might be received during the contest. I also release any photos that may involve myself.
_________________________________________________________________________
SIGNATURE (A Parent MUST sign if racer is under 18 yrs old)
Entry Fees (please circle one of the following)