Fax credit card entries only to 301-871-0006

Please do not mail after September 5 or fax after September 10!

Please fill out this form completely and legibly (print!) and sign the waiver before sending in.

____ I would like to volunteer.
____ I am a ChampionChip owner, and I have deducted $2 from my 
     entry fee. My ChampionChip number is:_______________ 
     (include full seven-character ID, i.e. CB12345)


Name: __________________________________________________________


Address: _______________________________________________________


City: ___________________________ State: _______ Zip: __________


Sex:  M   F   Age on Race Day: _____   T-shirt:   S   M   L   XL

  
Event:  ____5K    ____Fitness Walk    ____Kids' Sprint


Phone number:(______)___________________


E-mail address: ________________________________________________


____ I am participating on the team:____________________________
     Team category:  _____Co-ed    _____Male    _____Female
     Please submit all team members' entry forms together!


Entry Fee:
 $16 postmarked by July 19
 $18 from July 20 - September 6
 $21 from September 7 - September 12
 $25 race day
 $12 Kids' Sprint (no deadline)
$500 team competition (must be received by August 30)


____ I am making an additional contribution of $_______ for
     Children's Hospital.  Thank you for your support!


Please make check payable to "Spring Valley 5K Classic" or 
fill in credit card information below:


Credit card: ____________________________________ Exp.__________ 
(Mastercard or Visa only)


Total enclosed or charged: $________


Waiver
I know that running a road race is a potentially hazardous 
activity and that 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, traffic and the conditions of the road, 
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 organizers of the Spring Valley-
Sumner 5K Classic, W.C.&A.N. Miller Companies, Capital Running 
Company, USATF, and all other sponsors, their representatives 
and successors from all claims or liabilities of any kind 
arising out of my participation in this event or carelessness on 
the part of the persons named in this waiver. Further, I grant 
permission to all the foregoing to use my name and images of 
myself in any photographs, motion pictures, results, 
publications or any other print, videographic or electronic 
record of this event for legitimate purposes.  I also 
agree to return my rental ChampionChip or pay $35 for its 
replacement.


Signed: 


________________________________________________________________ 
Parent or guardian if under 18 years of age           Date