Name: _____________________________________________________   Sex: _______

Address: _________________________________________________________________

City: _____________________________   State: ________   Zip: _____________

Phone number: ______________________________   Age on 10/25: _____________

By signing this race application/waiver, I release Warren County High
School and the Shenandoah Valley Runners of any liability associated with
the Greasy-Gooney 10K, and I certify that I am in good enough health to
the best of my knowledge to safely run a 10K.


SIGNATURE: _________________________________   DATE: _____________________

Parent's or guardian's signature if you're under 18:


SIGNATURE: _________________________________   DATE: _____________________


Please mail checks for $12.00 (made out to "Warren County High School") &
entry forms by 15 October to:

   Patrick Farris
   Warren County High School
   240 Luray Avenue
   Front Royal, VA 22630