Saturday, July 21, 2007 -- Rock Cave, WV
Run the Rock 5K
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Please mail (and make checks payable) to: Tri-County Health Clinic, Inc.
PO Box 217, Rock Cave WV 26234, Attn: Karen Buckton (304) 924-6262 ext. 1022
NAME:___________________________________________
ADDRESS:________________________________________
CITY:_____________________________________________
STATE:_________________________ZIP:________________
PHONE#:__________________________________________
SEX:______AGE:_________
T-SHIRT SIZE: M_____ L_____ XL_____ XXL_____
PLEASE CHECK WHICH EVENT YOU ARE ENTERING:
Early Entry: 5K RUN___($15) 5K WALK___($15) Must be received by July 16th.
After July 16th and Day of the Race: $18.00
WAIVER: In consideration of the acceptance of this entry, I waive all rights and claims for damage that I may have against the Tri-County Health Clinic, Upshur County Fair and all sponsors. I attest that I am physically fit and have trained for this event.
_____________________________________________________
Signature of Participant
_____________________________________________________
Signature of Parent or Legal Guardian (IF UNDER 18 YRS OF AGE)