SOLO, ULTRA TEAM and RELAY TEAM 
CHAMPIONSHIPS
Saturday, September 6, 2008 at 7:00 a.m.
 
INDIVIDUAL & 5-PERSON TEAM ENTRY FORM
SEPTEMBER 6, 2008 GROUNDHOG FALL 50K
Name
Team Name (if any)
 (to qualify for 5-member Team Awards)
Address
City, State, Zip

Emergency Contact

Name Phone

Age on Sept. 6, 2008
Age Gender
Your E-Mail / Phone
 E-mail Phone
Housing Request
 How Many Persons?

T-Shirt Size

 Medium Large X-Large (guaranteed with preregistration)
Entry Fee
Extra Pre-Race Dinner Tickets

Adults Children (under 10)

Total Amount Enclosed
Questions/Comments
Complete the fields above, print the form, read and sign the waiver, then mail to the address below with a Check or Money Order

Waiver: By signature, I attest that I am physically fit and sufficiently trained to participate in this event. I have full knowledge of the risks involved. I further acknowledge that the race course contains uneven surface conditions, including, but not limited to, tree roots, streams, rugged terrain, potholes, and curbs which may create a risk; I further acknowledge that a part of the race is on public roads and that vehicular traffic may be encountered, and I accept these risks. Therefore, in consideration of the acceptance of my entry, I for myself, my heirs, my executors, and administrators waive any and all rights and claims for damages I may have against the Punxsutawney Road Runners Club, race sponsors, Punxsutawney Borough, Young and McCalmont Townships, and any individuals associated with this event and will hold them harmless for any and all injuries I may suffer in conjunction with this event. I HAVE READ AND UNDERSTAND THIS LIABILITY RELEASE.

Participant Signature _________________________________Date _________
(NOTE - No 50K participants under the age of 18)

INSURANCE PROVIDED BY ROAD RUNNERS CLUB OF AMERICA

PLEASE MAKE CHECKS PAYABLE TO Punxsutawney Road Runners Club
MAIL TO:  RD John Goss, 302 Indiana Street, Punxsutawney, PA 15767

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