Registration Mail-in Application

Women's Distance Festival - 2016 -  "Ladies Power Up "

Reston YMCA, 8:00 AM, Saturday, June 11, 2016

While on-line registration is preferred, you may register for the 2016 Reston Runners Women's Distance Festival using a printed version of this form. If you mail your registration, read the program waiver carefully. Sign the form. Your signature indicates your understanding of the program waiver.

All race participants will receive a commemorative gift if registered by June 1st.  Sign up early!!

Make check payable to: Reston Runners
Cost: $35 for entries postmarked by 1 June; Race Day Fee is $45.00
Mail to: WDF-2016, c/o Donna Rostant  11101 Chessington Place, Reston, VA 20194


Waiver

I know 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 official 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 high heat and/or humidity, conditions of the road and traffic on the course, 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 Reston Runners and their respective officers, the county of Fairfax, the Reston Association, 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. 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. I understand that bicycles, skateboards, baby joggers, roller skates, in-line skates, animals, and radio headsets are not allowed in the race and I will abide by this guideline.

 

2016 Women's Distance Festival Application Form

 

Event: 5K Run _______      5K Walk _______    Number (for official use only): ________

Mother/Daughter or Grandmother/Daughter/Granddaughter Team? ____(Y/N); Team mate(s): __________________________

Name (PLEASE PRINT): Last Name __________________; First Name _________________

Age/DOB: Age on race day:  ____yrs; DOB (mm/dd/yy):  ____/ ____/ ____

Address:_____________________________________

___________________, _____ ___________

Phone number: (______) _______ -- ____________

Shirt Size ___ Small         ___ Medium          ___ Large          _____X-Large

Sock Size ____ Small     _____ Medium      _____ Large

e-mail address: ________________________________

Are you a participant in the 2016 WTP? YES___ NO___

Participant Signature & Date (mm/dd/yy):

________________________________  ___/___/___

If under 18: Consenting Parent/Guardian Signature & Date

__________________________________________  ___/___/___

ENTRY NOT VALID WITHOUT SIGNATURE
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