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Saturday, August 2, 2003 -- Nutter Fort, WV
5th Annual Blackberry Festival 5K Run (CARS #10) (iPO Event Id#: 5532)

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ENTRY FORM
Name:_______________________________________________

Address:____________________________________________

City/State/Zip:_____________________________________
 
Phone:__________________________

Age on Race Day:______   Gender:  ___Male  ___Female 

Shirt Size: S___ M___ L___ XL___ 
Waiver: In consideration of acceptance of this entry to the West Virginia Blackberry Festival 5K Run, I waive all claims for myself, my heirs and assigns against the race sponsors, promoters, or officials due to injury or illness which may result from my participation. I attest and verify that I have full knowledge of the risk involved in these events. I am physically fit, and sufficiently trained to participate. I have read the above statement, I understand it, and my signature confirms its full acceptance.
____________________________________   _____________
Signature    Date
____________________________________   _____________
Parent/Guardian if under 18 years       Date  

Make check payable to and mail checks and application to the:
    West Virginia Blackberry Festival
    c/o Jack Merinar, Race Director
    Steptoe & Johnson
    P.O. Box 2190, Clarksburg, WV 26302