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                               2010 Bluemont Fair 10K Entry Form
                2010 Race day Registration at Great Country Farms, 7am - 8am
                              RACE Begins 8am, September 18, 2010


Name: ____________________________________________________________________

Address: _________________________________________________________________

City: ______________________________   State: _______   Zip: _____________

Phone number: _________________________    Date of birth: ________________

Sex: ________   Age: _________    Shirt size (circle one):    S    M    L    XL   XXL


Waiver:  In consideration of my application being accepted, I hereby, for myself, my heirs, 
and executors waive, release and forever discharge any and all rights and claims for damages, 
demands, or actions which I may have or may hereafter accrue to me against the Bluemont Fair 
10K, Race Committee, BCA, Great Country Farms, all sponsors and volunteers of the Bluemont Fair 
10K for any and all injuries suffered by me in any manner, in said event.                                                 


Runner's SIGNATURE: _______________________________ DATE: __________


Parent's SIGNATURE: _______________________________ DATE: __________  
Parent's or guardian's signature if entrant under 18

Payment

Please make checks payable to Bluemont Fair.

Completed form and check ($17) should be post-marked before September 10, 2010, and mailed to:        
   Bluemont Fair 10K Race                                                 
   Box 217                                                                
   Bluemont, VA 20135

After September 10, 2010, please bring completed form and check ($21) to the Bluemont Fair 
on race day.  Race forms will also be available at the registration desk.
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