Make check payable to: Golden Delicious Festival

Name:   ____________________________________________________

Address:  ___________________________________________________

___________________________________________________________

Phone:  ____________________________________________________

E-Mail Address:  _____________________________________________

Gender:  _______Male    _______Female   

Age:  _______ (as of September 21, 2008)

Choose one event for participation:  5k Run_______  5K Walk_______

Shirt size (check only one)Med___ Large____ X-Large____

Entry Fee for runners only:  $10.00

Liability Wavier: I, the undersigned, waive and release myself, my heirs, executors, and administrators, any and all rights and claims for damages, demands, and my other actions whatsoever, which I may have against all participating sponsors, supporters, and the Golden Delicious Festival, arising out of my participation in this event, including all injuries, including death suffered by me as a result of my participation in this event. I deem myself sufficiently trained for the completion of this event. Should I suffer from injury or illness, I authorize officials of this event to use the discretion to have me medically treated and transported to a medical facility.

_______________________________________________________

Signature (parent or gardian MUST sign if under 18 yrs of age)

___________________________

Date

Enclose Signed Registration Form and Fee (if applicable) and send to:

Golden Delicious Dash

P.O. Box 416

Clay, West Virginia  25043

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