Make check payable to: HealthyHuntington.org

Mail to: HealthyHuntington.org, C/O Jim Duke, 202 North Blvd., Huntington, WV 25701

Last Name:________________________________________________________

First Name:_______________________________________________________

Address:__________________________________________________________

City:_____________________________________________________________

State:____________ Zip:__________________________

Age (Required) ____________ Telephone(____________) _______________

Email(Optional)____________________________________________________

Gender: Male_____ // Female_______

Category: Runner_____ // Walker _____ // Fun Run_____

Shirt Size (Adult): S_____ // M_____ // L_____ // XXL_____ (add $1.50)

Children Complimentary T-shirt for Fun Run: M_____ // L_____

WAIVER STATEMENT (must be signed and submitted with registration-no exceptions)

As a participant in the River to Ridge 10M Trail Run/5K walk (Children's Fun Run), I assume complete responsibility for injury to me or damage to property which may occur during the event or while I am on the premises of the event. I hereby release and hold harmless HealthyHuntington.org, inc. sponsors, promoters, and all other persons associated with the event from any and all liability for injury or damage, whether caused by negligence of HealthyHuntington.org, inc., sponsors, promoters, or other persons associated with this event otherwise. I also understand and acknowledge that the event will be conducted on trails and the sponsor, promoters, and all other persons associated with this event will not be held responsible for the condition of the trails.

Signature Required for All Participants

X_________________________________________________________________ Date:_______________