Saturday, June 2, 2007 -- Charleston, WV
2007 Beat Beethoven 5K Fun Run/Walk
Please make checks payable to the WVSO and mail completed entry form to: Symphony Fun Run/Walk * P.O. Box 11887 * Charleston, WV 25339
NAME_______________________________________________________________
MAILING ADDRESS____________________________________________________
___________________________________________________________________
PHONE______________________________________________________________
EMAIL______________________________________________________________
AGE BRACKET: _____20 & Under /_____21-30 /_____31-40 /_____41-50 _____51-60 /_____61+ GENDER: ____Male or ____Female I Plan to: _____RUN ______WALK T-Shirt size:________________________Discalimer:"In consideration of your accepting this entry, I, the undersigned, intending to be legally bound, hereby, for myself, my heirs, executors, and administrators, waive and release any and all rights and claims for damages I may have against the West Virginia Symphony Orchestra, sponsors, the City of Charleston, the County of Kanawha, the State of West Virginia, and volunteers of the race, their representatives, successors and assignors, of any and all injuries suffered by me in said event. I attest and verify that I am physically fit and have trained for the competition of this race and my physical condition has been verified by a licensed medical doctor."
_______________________________________________________________ Signature (Parent/Guardian must sign if under 18)