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YES!! I Want to Make History... Please sign me up for the First Annual "Train on the Track - 5K"
July 24, 2010 -- Starting Time: 8:00 a.m.
Rain or Shine
(There will be a 2 hour delay in case of lightning/T-Storm)


Name______________________________________________

M___F___

Age on 7/24/10________  Are you now enrolled or graduated from Doddridge County High School?      Y   N   (Please Circle)

Address_____________________________City___________________

State______ Zip__________

Telephone______________________________________

Shirt Size: M______ L ______ XL ______  (T-s are pre-ordered ~ Late sign-ups: we can't guarantee your size)

Completed form and $8.00 should be received by WestUnionFest, Town of West Union, PO Box 5, 300 Court Street, West Union, WV prior to July 21, 2010.  (Applications accepted through 7:30 AM 7/24/10, but entry fee will be $10.00)

I do certify that I am physically fit and suitably trained to participate in the "Train on the Tracks - 5K" as a ___Walker /  ___ Runner.   I agree to be bound by all rules of the race and decisions of the officials. I hereby release and discharge the organization and sponsors holding this event, its agents, representatives, successors, and assigns from any and all claims, courses of action, and suits which shall or may have arisen as a result of my participation in said event.

I hereby give permission for my photograph to be taken and WestUnionFest is granted the right to use any and all pictures taken.  If the participant is a minor, I give my permission for his/her participation in this activity and for the race officials to act on my behalf in case of a medical emergency.

Signature of Applicant _______________________________________________ Date____________

Signature of Parent/Guardian __________________________________________ Date____________
(If applicant is under age 18)

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West Union, WV ~ We love our history - that's why we're still making it!