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| 2009 Entry Form |
Name: ___________________________________________________________________ Address: ________________________________________________________________ City: ______________________________ State: _______ Zip: ____________ Age on 10/24: _______ Date of birth: ___________________ Sex: _______ Phone number: ___________________________________________________________ E-mail address: _________________________________________________________ T-shirt: S M L XL none SVR member? YES NO (circle one) (circle one) |
| WAIVER: In consideration of your accepting this entry, I, the undersigned, intending to be legally bound, hereby for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against any of the following: the Shenandoah Valley Runners, the Warren Heritage Society, Terry Leckie, Karsten Brown, the owners of the property on which the race is being staged, and all additional contributors, sponsors and assigns for any injuries suffered by me in the scheduled October 24th, 2009 event. I attest and verify that I am physically fit and have effectively trained to complete this race. I understand the event's rules and restrictions, assume all risks associated with the event, and agree to abide by the decision of any race official relative to my participation. |
Signature: _____________________________________ Date: ________________ (Parent's or guardian's signature if registrant is under 18) |
| Please make checks payable to "Shenandoah Valley Runners" and mail to: Greasy-Gooney 10K c/o Karsten Brown 1195 South River Road Front Royal, VA 22630-8317 |
Entry fees $28 with a "performance fabric" shirt $12 without a shirt $1 discount for SVR members (Fees remain the same on race day) |
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| The Greasy-Gooney 10K Web pages are maintained by Karsten Brown. |
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