Saturday, June 2, 2007 -- Philippi, WV / Court House Bandstand
The Blue and Gray 5K
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Please Print Legibly- Enter All Applicable Information & Sign
NAME_____________________________________________________________ MALE ___ FEMALE ___
ADDRESS________________________________________________ Age on Race Day (6/2/07) ______
_________________________________________________________ T-SHIRT: M__ L__ XL__
PHONE _________________________________________________ EVENT: 5K Run ____ 5K Walk ____
In consideration of your acceptance of my application for entrance in the Blue and Gray 5KRun & Walk, I, for myself and anyone entitled to act on my behalf, waive and release the Barbour County Board of Education and Belington Elementary School, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event.
Signature of Entrant (Required) ___________________________________________________________ Signature of Guardian (if under 18) ________________________________________________________