NAME:______________________________________________________________________

ADDRESS:__________________________________________________________________

CITY:_______________________________ STATE:__________ ZIP CODE______________

PHONE:_________________________ E-MAIL:____________________________________

FEMALE   ____                      MALE  _____                          AGE ON   01/03/09_______

Must be 18 years of age

WAIVER: For and in consideration of my participation in the Snowflake 50k, I, the undersigned, release forever the WV Mountain Trail Runners, sponsors, its members, volunteers, co-sponsors, landowners, race organizers, race directors, other participants and all those associated with the Snowflake 50k from any claim for harm, injury or loss that occurs to me 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:__________________________________________________
                
Mike Dolin
4620 County Club Blvd.
South Charleston, WV 
25309