In the consideration of the acceptance of this entry in the Johnstown Inclined  Plane Run for Charcot-Marie-Tooth disease on September 19, 2010, I the undersigned participant (and if participant is under 18 years of age, parent or guardian), intending to be legally bound, do hereby for myself, my heirs, executors, and administrators, waive, release, and forever discharge any and all rights and claims for damages which I may have or which may hereafter accrue to me, against any and all persons, organizations, and legal entities affiliated with this race, for any and all damages which may be sustained or suffered by me in connection with this race. I also attest that, to the best of my knowledge, my physical condition and fitness are adequate for me to safely compete in this Run (Walk) and that no physician or qualified individual has advised me against competing.

___________________________________________________        ______________________

Signature (Parent or guardian if participant is under 18)                  Date

The Marah Griffith

Johnstown Incline Plane Trail Run and Nature Walk for

Charcot-Marie-Tooth Disease

October 15, 2011

LAST NAME:_____________________________ FIRST NAME:_______________________

ADDRESS:__________________________CITY:________________STATE____ZIP______

DAY PHONE:____-____-__________BIRTHDATE: ___/____/_____AGE ON 9/19/2010_______

E-MAIL:______________________________________GENDER_____________________

CIRCLE ONE: RUN     WALK                                                        

CATEGORY: CIRCLE ONE for RUN                                                           

MALE (King of the Mountain)   FEMALE (Queen of the Mountain)  

MALE MASTER (50+)        FEMALE MASTER (50+)

MALE (19 and under)         FEMALE (19 and under)

SHIRT SIZE:    S     M    L    XL    XXL

$................Entry Fee: $20.00 Adult age 14 & over

$................Entry Fee: $10.00 Child age 13 & under

$................Entry Fee: -Group rates-contact JD

I would like to make an additional donation to the Charcot-Marie-Tooth Foundation in the amount of $__________

Make Checks Payable to: The CMT Foundation    Questions: Call 814-539-2341 Ask for JD

Mail to:  CMT Foundation                                                     8:30      Check in

142 Gazebo Park                                                   9:30      Mandatory pre-race meeting

Johnstown, PA 15901                                           10:00     Race Begins

                                                                                                                               

How did you find out about this event?____________________________________________