--OFFICIAL ENTRY FORM--
2009 Fall into Winter 10K Race
Benefiting The Friends of the Reston Community Center
Reston Community Center, Reston, VA -- Sunday, December 6, 2009 at 9:00 AM

Make check payable to: Reston Runners ($25 for entries postmarked by November 25th; $35 for walk-in registration at Packet Pickup or on Race Day (Note: Online registration at SignMeUp.com  for $25 remains available until December 3rd)

Mail to : Reston Runners-FIW, P.O. Box 2924, Reston VA 20195

Note: ENTRY FEES ARE NON-REFUNDABLE.

RACE PACKET PICKUP and Late Registration .  Packet pickup is Friday, Dec. 4th (5 PM to 8 PM) and Saturday Dec. 5th (11AM to 4PM)  at Potomac River Running, Reston Town Center, 11911 Democracy Dr., Reston, VA 20190, (703) 689-0999.  On race day, December 6th, registration and packet pickup are available at the Reston Community Center, 2310 Colts Neck Rd, Reston, VA from 7:45 - 8:30AM.

For official race use DATE:
NUMBER:
Male____  Female____
NAME (print): LAST ____________________, FIRST ________________
ADDRESS: STREET ______________________________ CITY ___________ ST ___ ZIP ______
AGE ON RACE DAY:_____ DATE OF BIRTH(mm/dd/yy): ___/___/___
SHIRT SIZE:   ADULT Small___ Med___ Lrg___  XL___ 2XL___ PHONE: (       )__________
EMAIL: ______________
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.

ENTRY NOT VALID WITHOUT SIGNATURE(S):

___________________________________________________ RUNNER'S SIGNATURE

___________________________________________________  PARENT / GUARDIAN SIGNATURE FOR RUNNER UNDER AGE 18

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