MISSOURI VALLEY
ASSOCIATION WALKING CHAMPIONSHIPS
3000 M WOMEN - 5000 M MEN
HELD IN CONJUNCTION WITH CENTRAL METHODIST UNIVERSITY EASTER OPEN TRACK
MEET
THURSDAY APRIL 5, 2007
ENTRY FORM
Events and Entry Fees
$10.00 for either USATF Missouri Valley Championship race. No
additional entry fee for collegiate walkers not competing for
Championship. Pay day
of race.
Eligibility
Open to all athletes
eligible under USATF or IAAF rules. Collegiate
walkers need not be USATF Members to participate in race.
Membership required for all others. USATF Membership required to
compete for Missouri Valley Championships. Awards for top three
places in each Missouri Valley Championship race.
Personal Data
Name ________________________________________ Date of Birth
_____________ Gender (circle) M F
Address ______________________ City, State, Zip
Code __________________
Phone Number __________________ Email Address
_____________________
USA Citizen? Yes __ No __. If no, of what
country? _____________________
2007 USATF Number _________________
USATF membership required for participation by non collegiate USA
citizens or resident
aliens. Memberships available at
registration or on
line. Non collegiate non-resident aliens must be members of
their National
IAAF Member Federation.
Athlete's Release
In consideration of your accepting this entry. I hereby
for myself and/or as guardian of my child and for me/my child's heirs,
executors, administrators, waive and release any and all claims for
damage I may have against USATF-Missouri Valley, Central Methodist
University,
or individuals associated with this event
and their representatives,
successors, and assigns for any and all injuries suffered by me/my
child in said event. I attest and verify that I/my child am
physically fit and have sufficiently trained for the competition and my
/(child's) physical condition has been verified by a licensed
M.D. Further, I hereby grant full permission to any and
all of the foregoing to use a photograph, video-tape, motion picture or
any
record of this event for any legitimate purpose.
_________________________________________________
__________
Signature (Parent/Guardian must sign if under 18 years
of age) Date
Bring this form with entry fee on day of race
For more information contact:
Wayne T. Armbrust
(573) 445-6675
wta@tranquility.net