Saturday, June 30, 2007 -- Fayetteville, WV / Fayetteville Historic Court House
56th Annual New River Gorge Heritage Festival 5K Road Run/Walk
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NAME____________________________________________________
ADDRESS_________________________________________________
CITY/STATE/ZIP___________________________________________
PHONE # _________________________________________________
AGE ON RACE DATE____________MALE_______FEMALE_______
T-SHIRT SIZE (check one): S____ MED___ LG___ X-LG___
RACE (check one): RUN______ WALK_____
WAIVER: In submitting this entry, I, intending to be legally bound for myself, my heirs, executors and administrators, waive, release and forever discharge any and all rights and claims which I may hereafter accrue against the Town of Fayetteville, and the Fayetteville Fairs and Festivals Committee, any event sponsors, event volunteers, event staff, and their officers, directors, agents, successors and/or assigns for any injuries suffered by me at this event while traveling to and from the event or while participating in it. I attest and verify that I am physically fit and sufficiently trained for the competition of this event. I understand that I may be photographed and agree to allowing my photo, video, or film likeness to be used for any legitimate purpose by the aforementioned parties.
Signature___________________________________________
Date________________________________
(PARENT OR GUIARDIAN MUST SIGN IF UNDER 18 YEARS OF AGE)