First Name:

                                Age:

                                  Sex: Select One Female Male

                         Address:

                                City:

                              State:

                                  Zip:

                             Phone:

               Adult Shirt Size: Select One X Small Small Medium Large X Large XX Large (T-shirts available only to participants preregistered by March 31, 2012)

                               Event: Select One 5K 1K

Liability Waiver must be signed to participate in the Luray Earth Day 5K/1K on the Greenway I recognize that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race officials relative to my ability to safely complete the run. I assume all risks associated with running in this event including, but not limited to: falls, contact with other participants, the effects of the weather, including cold, snow, and/or ice, high heat and/ or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the organizers of the Luray Earth Day 5K/1K on the Greenway, its directors, officers, staff, and volunteers, the town of Luray, and its employees, and all sponsors, their representatives and successors 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. Further, I grant permission to all of the foregoing to use any photographs, motion pictures, recordings or any other record of this event for any legitimate purpose. For runners safety, I understand that headsets, bicycles, scooters, and roller blades are prohibited. Strollers are allowed. I ALSO UNDERSTAND THAT THERE ARE NO REFUNDS FOR THIS EVENT.

        Agree With Waiver: Select One Yes

    Participant Signature: (parents’ signature if under 18)

Online Registration Is Now Closed