TwoVirginias 5K


Register @ Bluefield Chamber of Commerce @ 619 Bland St, Bluefield, WV

8/25/2018


Top Male and Female runner will receive a $100 cash prize!
This is a point to point race from Bluefield, WV to Bluefield, VA
The awards ceremony will be following the race near the finish.
Transportation provided for participants back to the start.
Packet pickup @ 7 am
Race starts @ 9:00 a.m.

Pre-registration:
(ends 8/23/2018)
$25 adult 18 & up
$15 for 17 & below
$80 Teams of 2 to 5 runners
| Regular
| Registration:
$30 adults 18+ y/o
$20 for youths <12 y/o
Make checks payable to: City of Bluefield
Mail this form to: 1780 Stadium Drive
Bluefield, WV 24701
$100 top Male and Female Shirts guaranteed if register by the 8/17/2018
Headphones are NOT permitted on the course | Strollers are NOT permitted on the course
For more info contact
Charles Ridlehuber at 304-327-2401 Ext 2449
Two Virginias 5K
Male & Female Awards:

Overall (top 3)

Age Groups (top 3)
0-12,13-19,20-29,30-39,40-49,50-59,60-69,70+

TwoVirginias 5K

LAST NAME__________________________________ FIRST NAME_________________________ M.I._______

SEX____ DATE OF BIRTH____/____/____ AGE ON RACEDAY_____ E-MAIL____________________________

ADDRESS___________________________________________________________________________

CITY________________________ STATE_________ ZIP___________ PHONE (_______)_______-___________

RACE DAY EMERGENCY CONTACT (NAME AND PHONE)_________________________________________

TEAM NAME____________________________

*** CIRCLE SHIRT SIZE: YS, YM, YL, XS, SM, MD, LG, XL, XXL

IN CONSIDERATION FOR ACCEPTING MY ENTRY IN THIS RACE, I FOR MYSELF, MY HEIRS, EXECUTORS AND ADMINISTRATORS, WAIVE AND RELEASE FOREVER ANY AND ALL RIGHTS AND CLAIMS FOR DAMAGES I MAY HAVE AGAINST THE ORGANIZERS AND SPONSORS OF THIS EVENT. I ALSO RELEASE THE ABOVE NAMED FOR ALL CLAIMS OF DAMAGE DEMANDS, AND ACTIONS IN ANY MANNER DUE TO ANY PERSONAL INJURIES, PROPERTY DAMAGE, OR DEATH SUSTAINED AS A RESULT OF MY TRAVELING TO AND FROM AND MY PARTICIPATION IN SAID RACE. I ATTEST AND VERIFY THAT I AM PHYSICALLY FIT AND HAVE SUFFICIENTLY TRAINED FOR THE COMPETITION OF THIS EVENT. IN FILLING OUT THIS FORM, I ACKNOWLEDGE I HAVE READ AND FULLY UNDERSTAND MY OWN LIABILITY AND ABILITY. STROLLERS ARE NOT ALLOWED ON THE RACE COURSE. PARTICPANTS USING HEADPHONES ARE NOT ALLOWED ON THE RACE COURSE.

SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18)


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