Spring Valley 5K Classic Entry Form

Registration Form for Spring Valley/Sumner Community 5K Classic
The Shops at Sumner Place, Bethesda, MD
Saturday, September 8, 2001 - 8:30 AM

Make check payable to: Spring Valley 5K Classic Race Web Site: http://5K.wcanmiller.com
Mail to: Spring Valley 5K, 13710 Ashby Road, Rockville, MD 20853-2903
Fax credit card entries to: (301) 871-0006 until September 5 Don't mail after August 31
For Sponsorship/Exhibit Space please call 202.895.2736

Today's Date: , 2001 Event: 5K Run 5K Fitness Walk 1/4 Mile Kids Sprints
5K Entry Fee: $18 $23 after August 24 and on Race Day
5K Fitness Walk Fee $18 $23 after August 31 and on Race Day
Kids Sprint Entry Fee $12 at all times.
I am a ChampionChip owner and am deducting $2. My Chip number is ChampionChip
I want to buy my own ChampionChip. I am enclosing $35 payable to Capital Running Co.
I want to volunteer Additional contribution to Children's Hospital $________________

First Name: Last Name:
Address:
City: State: Zip: -
Age on race day: Sex: M F
Date of Birth: / / Shirt Size: M L XL
Home Phone: - - E-Mail:

Credit Card: MC Visa --- Exp:

Cardholder's Signature (Mandatory) __________________________________________

Waiver/Release Must be Signed Before Mailing:

I know that running is a potentially hazardous activity and I should not enter unless I am medically able and properly trained. I assume all risks associated with running in this event including, but not limited to, falls, contact with other participants, the effects of weather and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing the facts and in consideration of your accepting my entry, I, for myself, and anyone else acting on my benefit waive and release and indemnify the organizers of the The Spring Valley 5K, W.C. and A.N. Miller Companies, Capital Running Company, USATF, plus all sponsors, their representatives and assignors from all claims or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. Race Management Services and Finish Line Services by Capital Running Company.

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Signature (parent or guardian if under 18) Date