Name______________________________________Age on 8/22/08___________Gender_______
Address________________________________________________________________________
City_________________________________ State______________________ Zip_____________
Phone____________________________ E-mail ________________________________________
13 Hour Time Limit - must be 18 or older - Limit 100 - 9:00pm start
13 hour finishers will receive a
Patagonia . S
M L XL
_________
silkweight mens/womens sizing
Application Fee: $55 if postmarked by 8/1/08. After 8/1, $70.
_________
Additional Saturday lunch $7
_________
Total Enclosed: payable to WVMTR _________
Refund minus $10 will be granted up to 8/1/08
In consideration of your acceptance of my application, I, for
myself, my heirs, my executors, and
administrators, waive any and all rights and
claims for damages I may have against the WVMTR,
Race Directors, and their
agents and sponsors for any and all injuries suffered by me during the
Cheat Mountain Moonshine Madness. I hereby, by my signature, certify that I am at least 18 years of
age, I
acknowledge reading and understanding this clause, and attest and verify
that I am aware of the
hazards and am physically fit and have trained sufficiently for this event. Race
management reserves
the right to stop any
participant who in their opinion is not fit to continue.
Signature _________________________________________________Date_________________
Mail To: CMMM Run Adam Casseday 7 Park Ave Beverly, WV 26253