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• $10 for members of Northern Virginia Running Club (you may join NOVA for $20)
Enter on-line
-- To encourage on-line entry, you will NOT be charged a transaction fee -- where it says $18, you will be charged only $18!
Enter by mail [Word] [PDF]
or use the form below
Call 703-927-4833 or e-mail with any questions
Please mail this form to NOVA, 611 South Ivy Street, Arlington VA 22204
By entering this event, I agree, warrant and covenant as follows: I know that running is a potentially hazardous activity. I should not enter or run in club activities 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 race including, but not limited to, falls, contact with other participants, the effects of weather, including high heat and/or humidity, the 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 acceptance of my application, I, for myself and anyone entitled to act on my behalf, waive and release Arlington County Virginia and its elected officials and employees, Northern Virginia Running Club, Julia Campbell Memorial Foundation, Road Runners Club of America, and all sponsors, their directors, officers, employees, agents; 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 acknowledge that the application fee shall be non-refundable. I agree that Northern Virginia Running Club or Julia Campbell Memorial Foundation may use my name and likeness for publicity purposes.
________________________________________________________ Signature (parent or guardian if under 18)
First Name _____________________________________ Last Name _____________________________________
Gender [M][F] Age on 4/24/08 [___] Birthdate ___ ___ - ___ ___ - ___ ___ ___ ___ (mm/dd/yyyy)
Address _________________________________________________________________________________________
City _____________________________________________ State ________ ZIP ___________________________
Email ___________________________________________________________ Phone _________________________
T-shirt size: [S] [M] [L] [XL]
Enclosed is my entry fee of $____ payable to NOVA
I want to join NOVA. Enclosed is my membership of $____ payable to NOVA (you may join NOVA for $20)
Enclosed is an additional donation of $___ payable to Julia Campbell Memorial Foundation – www.jcmf.org
Northern Virginia Running Club and Julia Campbell Memorial Foundation will keep your personal information private.
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