West Virginia Mountain Trail Runners

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