Saturday, May 31, 2008 -- Philippi, WV
Blue & Gray 5K
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Send registration form and check or money order to:
Belington Elementary School, RR 2 Box 344, Belington, WV 26250
Please Print Legibly- Enter All Applicable Information & Sign
NAME___________________________________________________________________________
Age on Race Day (5/31/08) __________
ADDRESS_________________________________________________________________________
City/State______________________________________________________________________
Telephone(_______________)____________________________________
(circle one for each) Gender Male OR Female // Event Run OR Walk // Shirt Size S, M, L, or XL
Waiver: In submitting this entry, I, intending to be legally bound for myself, my heirs, executors and administrators, waive, release and forever discharge any and all rights and claims which I may hereafter accrue against Belington Elementary School, any event sponsors, event volunteers, event staff, and their officers, directors, agents, successors and/or assigns for any injuries suffered by me at this event while traveling to and from the event or while participating in it. I attest and verify that I am physically fit and sufficiently trained for the competition of this event. I understand that I may be photographed and agree to allowing my photo, video, or film likeness to be used for any legitimate purpose by the aforementioned parties.
Signature of Entrant (Required)
_______________________________________________________________________________
Signature of Guardian (if under 18)
________________________________________________________________________________