Sunday, March 20, 2011 -- Grafton, WV / Grafton High School, 400 Riverside Dr.
Grafton 5M Run, 2M Walk, Kids Run ENTRY FORM
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RACE CONTACT: Eva Robinson (e-mail) erobinso@access.k12.wv.us, (phone) 304-265-3046 /daytime only
FEE 5 Mile Run & 2 Mile Walk: $18 (by 3/14/11), $20 (after 3/14/11), $10.00 (on race day WITHOUT T-shirt)
FEE Kids Run: $3.00 (WITHOUT shirt)
Payable to: GHS 10th Grade Class, Eva Robinson . . . Mail to: Grafton High School, 400 Riverside Drive Grafton, WV 26354
NAME:_____________________________________________________________________________ STREET:___________________________________________________________________________ CITY:____________________________________________STATE:________ZIP:_______________ PHONE:(__________) _______________-______________________ EMAIL:___________________________________________________ EVENT: 5 Mile Run:___ 2 Mile Walk:___ Kids Run:___ // MALE:____ or FEMALE:____ AGE:___ (On March 20, 2011) // SHIRTS SIZE (adult): S M L XL
WAIVER: In consideration of the acceptance of this entry, l 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. l also release any photos that may involve myself.
__________________________________________________________________________________ SIGNATURE --- (Parent or Guardian, if participant under 18 years old)