Entry Fees (Include night running vest, food and drink at aid stations, breakfast following the run)

10 K...............$20

10 Mile..........$20

20 Mile..........$25

30 Mile..........$30

40 Mile..........$35

Pike Valley Alumni Receive a $5 Discount

Submitting Your Entry

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To enter by mail simply print the form below, sign it and send a check or money order for the appropriate amount to :

John Neal,  Lunar Trek

PO Box 28

Scandia,    Kansas    66966

Lunar Trek Entry and Release Form 

10k, 10-Mile, 20-Mile, 31-Mile (50K), 40.4-Mile Runs

Friday, July 18, 2008 (Full Moon)

Pike Valley High School

Scandia, Kansas

Start  11:00   P.M.    ( that is at night )

Name: __________________________________________

Address: ________________________________________

City: _______________________State: _____ Zip: __________________________

E-mail Address: ______________________________________________________

Phone # ____________________

A Nike Running Safety Vest and Swoosh Safety Light is Given to each entrant.   Some form of night safety running apparel and or lights is required.

Date of Birth (mm/dd/yy)____/_____/_____       Age on 07/18/2008 _____         Gender (Circle):  M   F

Number of Ultramarathons completed: ________ Number of trail races completed_________

Race Entry (Check race)

10K ______       10-Mile_____       20-Mile _____       31-Mile(50K)_____       40.4-Mile_____

_____________    __________________    _____________

Name                          Address                             Phone # of Person to Contact in case of an emergency:

WAIVER: By signing below, you agree, warrant and covenant as follows: I know that running and volunteering in running events are potentially hazardous activities. I assume all risk associated with these activities. I hereby waive and release, for myself and anyone entitled to act on my behalf,

The Pike Valley Schools USD 426 and all staff organizers and directors of the Lunar Trek run, and all sponsors and race officials from all claims of any kind arising out of my participation in this event. In consideration of the foregoing, I, for myself, my heirs, executors, administrators, personal representatives, successors and assigns, waive and release any and all rights, claims and courses of action I have or may have against the Lunar Trek Run and USD 426, and any and all sponsors, their representatives and successors, that may arise as a result of my participation in this Lunar Trek Run event and any preand post- event activities. I understand that this event may cause serious bodily harm including broken bones and even death. I attest and verify that I am physically fit and have sufficiently trained for the completion of this event and my physical condition has been verified by a licensed medical doctor. I understand fully that race management can remove me from the race for any legitimate reason they see fit.  Be aware that the director(s) and officials of our race event(s) may postpone or cancel said event(s) for safety reasons due to severe weather, high winds, near-by lightning, or "other" serious safety issues. We are not responsible for weather-related and "other" safety issues beyond our immediate control. We reserve the right not to reimburse entry fees for races postponed or cancelled due to safety issues. Further, I hereby grant full permission to any and all of the foregoing to use any photographs of this event for any legitimate purpose including event advertising.

Signature: ______________________________________________________ Date___________

Signature of Parent (if under 18 years old) :_____________________________ Date___________

By signing and submitting this form I agree to wear appropriate a night safety garment and/or safety lighting while participating in the Lunar Trek.

Please sign, date and return the waiver. Make checks payable to “USD 426 Pike Valley Schools” and mail to:

John Neal,    Lunar Trek Run,    PO Box 28,   Scandia,    Kansas    66966