Greasy-Gooney 10K - Click image to load a new image randomly

2019 Entry Form

Name: __________________________________________________________________

Address: _______________________________________________________________

City: _____________________________   State: _______   Zip: ____________

Age on 10/26: _______   Sex: _______   Date of birth: __________________

Phone number: __________________________________________________________

E-mail address: ________________________________________________________

Okay to e-mail you about upcoming races? (see below)  ____ yes  ____ no 

Entry fee:  ____ SVR member WITH cap       ____ SVR member, NO cap      
(check one)      ($18 early/$23 race day)       ($12 early/$17 race day)

            ____ Other club* WITH cap      ____ Other club*, NO cap     
                 ($19 early/$24 race day)       ($13 early/$18 race day)

                      *Specify club(s): ________________________        

            ____ Non-member WITH cap       ____ Non-member, NO cap      
                 ($20 early/$25 race day)       ($14 early/$19 race day)

Add'l 2019 green                  Leftover 2017 navy                    
caps ($8 each): ________          beanies ($5 each): ________           

Leftover 2018 black               Leftover 2018 pint                    
beanies ($5 each):  ________      glasses ($2 each): ________           

Optional donation to the Humane Society of Warren County: $_____________
   (100% of this donation goes to the HSWC; see for details)  

WAIVER: In consideration of your accepting this entry, I, the undersigned, intending to be legally bound, hereby for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against any of the following: the Shenandoah Valley Runners, Karsten Brown, the Browntown Community Center Association, the owners of the property on which the race is being staged, and all additional contributors, sponsors and assigns for any injuries suffered by me in the scheduled October 26th, 2019 event. I attest and verify that I am physically fit and have effectively trained to complete this race. I understand the event's rules and restrictions, assume all risks associated with the event, and agree to abide by the decision of any race official relative to my participation.

Signature: _____________________________________   Date: _______________
(Parent's or guardian's signature if registrant is under 18)

Please make checks payable to "Karsten Brown" and mail to:

Greasy-Gooney 10K
c/o Karsten Brown
1195 South River Road
Front Royal, VA 22630-8317

(Privacy note: Your personal information will be kept private and will not be shared with anyone. The race director sends out one or two e-mails each year to promote the Greasy-Gooney 10K and a few other races in the area; you are free to specify above whether or not you want us to send you such e-mails.)

The Greasy-Gooney 10K Web pages are maintained by Karsten Brown.