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DIRTY DOG 15K
TRAIL RUN
MAY 17, 2008
Female_____
Male_____ Age on May 17, 2008_______
NAME:______________________________________________________________________
ADDRESS:__________________________________________________________________
CITY:_______________________________ STATE:__________ ZIP
CODE______________
PHONE:_________________________
E-MAIL:____________________________________
Is your dog participating? Yes_____ N/A_____ Dog's
Name:_______________________
Technical Trail Runner Tee SIZE: S______ M______ L_____
XL_____
(T-shirt guaranteed to first 150 registrants.)
Are you participating in the
2008 Mountain State Trail Run Series?
YES NO
Pre-registration is $20 if postmarked by
MAY 10, 2008 and $25 thereafter. Race day registration will be from 7:30
to 8:30 am.
WAIVER: For and in consideration of my participation
in the DIRTY DOG 15K TRAIL RUN
in Charleston, WV, I, the undersigned, release forever the sponsors, the
program, its members, volunteers, co-sponsors, landowners, race
organizers, race directors, other participants and all those associated
with the DIRTY DOG 15K TRAIL RUN
from any claim for harm, injury or loss that occurs to me or my
child/ward or anyone on his/her behalf as a result of participation in
this event. I therefore attest and verify that I am physically fit and
have sufficiently trained for this event and am aware of the potential
dangers.
SIGNATURE:__________________________________________________
(PARENT/GUARDIAN IF UNDER 18)
Please make checks payable to:
WVMTR (WEST VIRGINIA MOUNTAIN TRAIL RUNNERS)
Mail entry forms to:
Daniel Todd
DIRTY DOG 15K TRAIL RUN
609 Albert Street
Charleston, WV 25302
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