36th Annual Charleston Distance Run

15 Mile, 3-Person 15 Mile Relay, 5K Runs & 5K/10K Walks

Saturday, August 30, 2008, 7:30am – Charleston, WV

 

Send check or money order to:                        15 Mile Race                                                          5K Race, 5K and 10K Walks, and

Charleston Distance Run Committee                        $25  Postmarked by July 31, 2008                          3-Person 15 Mile Relay (each person)

PO Box 11595                                                          $35  Up to August 20, 2008                                    $20  Postmarked by August 20, 2008

Charleston, WV  25339                                            $45  Up to August 29, 2008, 9pm                           $30  Up to August 29, 2008, 9pm

 

After 12 noon on Friday, August 29, 2008, applications will ONLY be accepted at the Charleston Civic Center, from 4 to 9pm

                                                                                >>> NO REFUNDS ON ANY FEES <<<

                            Website: www.charlestondistancerun.com                              Phone: 304-345-5433 (voice mail)

 

Check appropriate race:    15 Mile ______        3-Person 15 Mile Relay ______         5K ______         5K or 10K Walk _______

 

                                PLEASE  PRINT  CLEARLY

 

_____________________________________________________________________________      MALE _____            FEMALE _____

LAST NAME                                            FIRST NAME                                            MI

 

_____________________________________________________________________________      AGE ON 8/30/2008 ________

STREET ADDRESS or PO BOX

 

_____________________________________________________________________________      DATE OF BIRTH ____/____/____

CITY                                                        STATE                                     ZIP CODE

 

(______)____________________         (______)____________________         _______________________________

                HOME PHONE                                          WORK PHONE                                                         E-MAIL

 

FREE RUNNER’S T-SHIRT SIZE:               (All shirts adult sizes - Circle one):                 S    MED    L    XL    XXL

 

OPTIONAL Souvenir Shirt:     (Please include payment with entry fee)

 

   $10/ea   Short Sleeve (indicate size ______& quantity ______)            $15/ea   Long Sleeve (indicate size ______& quantity ______)

 

Circle one:               INDIVIDUAL             WHEELCHAIR          HANDCYCLE           15 MILE TEAM         3-PERSON 15 MILE RELAY

 

IF 15 MILE TEAM   (Circle one):   FEMALE OPEN      MALE OPEN      FEMALE MASTERS      MALE MASTERS      MIXED

 

IF 3-PERSON 15 MILE RELAY  (Circle one):   MALE     FEMALE     MIXED     MALE MASTERS     FEMALE MASTERS

 

NAME OF TEAM / RELAY: __________________________________________________________________________________

 

Team and relay applications must be submitted together, otherwise applicants will be limited to the individual classifications. For team

entries a maximum of four (4) team members, with only the three (3) top members to determine the standings in the Team competition.

 

Predicted time this race: _____________               Last year’s time: _____________

 

Best Times 2007-2008:           5K________   10K________    20K_________    ½ Marathon_____________     Marathon______________

 

WAIVER: I, the undersigned, waive and release myself, my heirs, executors, and administrators, any and all rights and claims for damages, demands, and any other actions whatsoever, which I may have against the Charleston Distance Run Committee, the City of Charleston, the Charleston Regatta Commission, all participating sponsors and supporters of those entities, successors, representatives, and assigns, arising out of my participation in this event, including any and all injuries including death suffered by me as a result of my participation in this event.  I consider myself adequately trained for the completion of this event.  Should I suffer an injury or illness, I authorize officials of this race to use their discretion to have me medically treated and transported to a medical facility.  I also authorize the Charleston Distance Run Committee to use any photograph or video taken of me during any of the Charleston Distance Run events to be used in any promotional materials.

 

 

_________________________________________________________________                              ____/____/____

                SIGNATURE  (Parent or Guardian MUST sign if under 18)                                                             DATE