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                                                                REGISTRATION FORM

Please clearly print your entry form (One per Entrant) and send with your check or money order to:  

      Capon Valley Ruritan 5K, P.O. Box 5 , Yellow Spring, WV 26865

Name________________________________________________________________Sex______

Age (as of 10/11/08)_______

Address_______________________________________________City/State/Zip______________________________________

Phone______________________E-Mail_________________________Entry (circle)      5K          1 MileFun           Kids 1Mile    

Tee Shirt Size (circle one):       Small      Medium    Large     XLarge         ___ Tee Shirt for 1 Mile Entrant/Kids1 Mile

Entry Fee Enclosed: (Circle)      5K - $16. ($14. SVR)           Fun Walk  - $5. Tee -$7               Kids 1 Mile- $5. Tee - $6   

In consideration for the acceptance of this entry, I hereby for myself (my child) my heirs, executors, and administrators waive and release any and all  claims that I may have against the Race Organizers, Officials, Sponsors, Shenandoah Valley Runners, and/or  the Capon Valley Ruritan Club.  I certify that I am  (my child is)  physically fit for this event.

SIGNATURE (parent or guardian if under 18):______________________________________________________Date:___________________

All proceeds help support the Capon Valley Ruritan Club services to the community.