Entry Form
VALLEY FALLS 10 MILE & 10 K TRAIL RUN
October 6, 2012
10 Mile Run________ 10 K Run___________
Female_____ Male_____ Age on October 6, 2012_______
NAME:_________________________________________________________________
ADDRESS:_____________________________________________________________
CITY:__________________________ STATE:__________ ZIP CODE______________
PHONE:____________________ E-MAIL:____________________________________
Long sleeve T-shirt SIZE: S______ M______ L_____ XL_____ XXL_________
(T-shirt guaranteed to preregistrants.)
Pre-registration – $20 (if postmarked by Sept 24, 2012) _____________
Late registration – $25 _____________
Additional donation to Immune Deficiency Foundation (IDF) _____________
Total amount enclosed _____________
Race day registration will be from 8:00 to 9:30 am, with race starting at 10:00am sharp.
WAIVER: For and in consideration of my participation in the VALLEY FALLS 10 MILE & 10 K TRAIL RUNS in Fairmont, 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 VALLEY FALLS 10 MILE & 10 K TRAIL RUNS 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:
Mark Flood
VALLEY FALLS TRAIL RUNS
123 Kelly Street
Clarksburg, WV 26301
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