SOLO, ULTRA TEAM and RELAY TEAM 
CHAMPIONSHIPS
Saturday, September 6, 2008 at 7:00 a.m.
 
RELAY TEAM ENTRY FORM
SEPTEMBER 6, 2008 GROUNDHOG FALL 50K
Names (Both)
Addresses (Both)
City, State, Zip (Both)

Emergency Contact

Ages on Sept. 6, 2008
Age Gender
Age Gender
Your Phone
Email
Team Category
 Team Name
Housing Request
 How Many Persons?

T-Shirt Size

 Medium Large X-Large Medium Large X-Large
Relay 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, we attest that we are physically fit and sufficiently trained to participate in this event. We have full knowledge of the risks involved. We 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; We further acknowledge that a part of the race is on public roads and that vehicular traffic may be encountered, and We accept these risks. Therefore, in consideration of the acceptance of our entry, each of us for ourselves, our heirs, our executors, and administrators waive any and all rights and claims for damages we 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 either of us may suffer in conjunction with this event. EACH OF THE UNDERSIGNED HAS READ AND UNDERSTANDS THIS LIABILITY RELEASE.

Participant #1 Signature _________________________________Date _________

Participant #2 Signature _________________________________Date _________

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

Print Map