Mt. Mania Registration

Name:________________________________________________________________ age on event day:__________

Gender: ____ Female   ____ Male            CIRCLE ONE:  5k      10k

T-shirt size (circle one):  S    M    L    XL    XXL

Mailing Address:_________________________________________________________________________________

City/State/Zip:___________________________________________________________________________________

Phone:_____________________________________  Email:______________________________________________

Assuming the acceptance of this entry, I for myself, my heirs and executors, hereby release the Mt. Mania Committee, Castle Rock Lion’s
Club,  Cowlitz Valley Runners, all event sponors, City of Castle Rock, its council, staff and volunteers, as well as Cowlitz County and
its Board of Commissioners and staff, Washington State Patrol and its officers from any and all liabilities arising from any
illness, injury or damage incurred as a participant in this event.

Signature: ________________________________________________________________ Date:__________________

Signature of Parent/Guardian if under 18 years of age:

_________________________________________________________________________ Date:__________________

Checks payable to: Cowlitz Valley Runners     

Mail form to: Mt. Mania, P.O. Box 968, Castle Rock, WA 98611

FEES:

Pre-registered -- $15 all ages, $13 CVR members

Day-of event -- $20 all ages, $18 CVR members