Share |

Sunday, November 23, 2008 -- Rowlesburg, WV / City Park
K of C Rowlesburg 10K and 5K Run - MAGP Endurance #9 (iPO Event Id#: 10833)

Return to the Details Page

Entry Fee: Fee is $15.00 if postmarked by November 15th and $20.00 thereafter

Make checks to: CPMS Cross Country
Mail To: David G. Pauly, Rt. 1 Box 1146, Kingwood, WV 26537

Name: ___________________________________________________ Male: ___Female____

Address: ________________________________________________ Birth Date: __/___/___

City: ______________________________________________State: ______Zip: __________

Phone: ( )_________________________ Shirt Size: S M L XL Age:______

Choose Race: _______10-K --- OR --- ______ 5-K

In consideration of your acceptance of my application for entrance in the Rowlesburg 5 & 10-K River Run I, for myself and everyone entitled to act on my behalf, waive and release the Knights of Columbus #9578, the town of Rowlesburg, Central Preston Middle School, and all sponsors, for all claims of damage, demands, actions whatever in any manner arising out of my participation in said athletic event. I attest and verify that I have full knowledge of the risks involved in this event and I am physically fit and sufficiently trained to participate in this event.

Signature of Applicant: ___________________________________ Date: ________

Signature of Parent: ______________________________________ Date: ________
(If under age 18)