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Imagination Running Wild Registration
Date
(mm/dd/yyyy)
Number of Adult Participants (not related)
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1 adult
2 adults
3 adults
4 adults
5 adults
6 adults
Family Discount: Number of Additional Family members- spouse / partner and /or kids
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1
2
3
4
5
Amount
*
Quantity
$40
-
per participant
0
1
2
3
4
5
6
7
8
9
10
10
$20
-
additional family members
0
1
2
3
4
5
6
7
8
9
10
10
$10
-
MRTC donation in increments of $10
0
1
2
3
4
5
6
7
8
9
10
10
Contact Information
Name
First Name
Last Name
Email
Verify Email
Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
T-Shirt Size (sizes listed reflect adult unisex)
select one
XS
Small
Medium
Large
X-Large
XX-Large
XXX-Large
XXXX-Large
#2 Additional Participant Name
Email
Verify Email
T-Shirt Size (sizes listed reflect adult unisex)
select one
XS
Small
Medium
Large
X-Large
XX-Large
XXX-Large
XXXX-Large
#3 Additional Participant Name
Email
Verify Email
T-Shirt Size (sizes listed reflect adult unisex)
select one
XS
Small
Medium
Large
X-Large
XX-Large
XXX-Large
XXXX-Large
#4 Additional Participant Name
Email
Verify Email
T-Shirt Size (sizes listed reflect adult unisex)
select one
XS
Small
Medium
Large
X-Large
XX-Large
XXX-Large
XXXX-Large
#5 Additional Participant Name
Email
Verify Email
T-Shirt Size (sizes listed reflect adult unisex)
select one
XS
Small
Medium
Large
X-Large
XX-Large
XXX-Large
XXXX-Large
#6 Additional Participant Name
Email
Verify Email
T-Shirt Size (sizes listed reflect adult unisex)
select one
XS
Small
Medium
Large
X-Large
XX-Large
XXX-Large
XXXX-Large
Participant Waiver
*
In consideration of your acceptance of my registration for the Imagination Running Wild Challenge, I, for myself and anyone entitled to act on my behalf, waive and release the MRTC, BOPARC, the City of Morgantown, the Town of Reedsville, the Town of Star City, MCPARC, the National Road Heritage Corridor, West Virginia University, WV Land Trust, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. I also release the use of any photographs that may include me. I assume the risks for any injuries that I may sustain while participating in this event.
I agree
Participant Waiver Under 18
If under 18, I the parent / guardian of the participant, waive and release the MRTC, BOPARC, the City of Morgantown, the Town of Reedsville, the Town of Star City, MCPARC, the National Road Heritage Corridor, West Virginia University, WV Land Trust, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my child's participation in this event. I also release the use of any photographs that may include them. I assume the risks for any injuries that they may sustain while participating in this program.
I agree
Add 3% to my total amount to help cover the payment processing fees