Way Off Track 10 K Entry Form Name of Participant Age on Race Day Shirt size (adult S/M/L/XL/XXL youth S/M/L) Gender Birthdate WAIVER: In acceptance of this entry, I hereby release the Armstrong Rails to Trails Association and the Allegheny Valley Land Trust and any of its representatives involved in the face from any & all contentions of claims of damages or injuries suffered by myself and/or registered participants as a result of participating in this event. I attest that the person(s) I am registering are sufficiently trained & physically fit for this event. __________________________________________________________ #1 Signature (parent must sign for minor under 18 date __________________________________________________________ #2 Signature (parent must sign for minor under 18 date __________________________________________________________ #3 Signature (parent must sign for minor under 18 date __________________________________________________________ #4 Signature (parent must sign for minor under 18 date __________________________________________________________ #5 Signature (parent must sign for minor under 18 date ENTRY FEES Mail completed application & check payable to: $25.00 register before 6/1/15 $30.00 register after 6/1/15 Armstrong Rails to Trails Association P.O. Box 422 Kittanning, PA 16201 Contact John Pryde 724 548-7485 with any questions