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| 2007 Entry Form |
Name: ___________________________________________________________________ Address: ________________________________________________________________ City: ______________________________ State: _______ Zip: ____________ Age on 10/27: _______ 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 27th, 2007 event. I attest and verify that I am physically fit and have effectively trained to complete this race. |
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 $12 if postmarked by Wednesday 10 October $15 thereafter and on race day $1 discount for SVR members $4 discount for those not wanting a t-shirt |
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| The Greasy-Gooney 10K Web pages are maintained by Karsten Brown. |
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