Saturday, May 12, 2012 -- Fairmont, WV
Run to Read 5K & 15K ENTRY FORM
Run to Read Triple Crown #2 & #3

You have the option to [ Register Online ] with runsignup.com.

Return to the Details Page ... RACE CONTACT: Iva Marion (e-mail) lvamarion@hotmail.com

Mail to: LV of Marion County, 601 Locust Ave., Fairmont WV 26554 ... Checks payable to: Literacy Volunteers of Marion County

Entry Fees (please check one of the following)

• _____ 5K Run --- $15 ($20 after 4/12/12, $25 after 5/8/12)

• _____ 5K Walk -- $15 ($20 after 4/12/12, $25 after 5/8/12)

• _____ 15K Run -- $15 ($20 after 4/12/12, $25 after 5/8/12)

• _____ 15K + 5K --$25 ($30 after 4/12/12, $35 after 5/8/12) This fee covers timing in 2 events, up to 2 awards and 1 shirt.

• _____ Fun Run/Walk $10 ($15 after 4/12/12, $20 after 5/8/12)

• $_________ Extra donation to Literacy Volunteers Of Marion County

• $_______________ TOTAL AMOUNT

NAME _________________________________________________________________________

ADDRESS_______________________________________________________________________

CITY__________________________________________________________________________

STATE, ZIP ___________________________________________________________________

PHONE (___________________)___________________________________________

AGE _____(on 5/12/12) -- BIRTHDATE _____/_____/__________ -- MALE_____ or FEMALE_____

EMAIL (OPTIONAL)__________________________________________________________

SHIRT SIZE: Adult XS___S___ M___ L___ XL___ ... 2012 shirts are windshirts. These are 1/2 size larger than normal sizes.

WAIVER: I 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. I also release any photos that may involve myself.

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SIGNATURE ... (A parent/guardian MUST sign if racer is under 18 yrs old)