Saturday, June 19, 1999 -- Charleston
Mountaineer Spirit 5-Mile Run & 2 Mile Fun Walk

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LAST NAME__________________________FIRST NAME___________________



ADDRESS_________________________________________________________
       (including apt. #) 


CITY_____________________________STATE____________ZIP___________



MALE_____ FEMALE_____  PHONE #_________________________________
                              (including area code)

AGE ON RACE DAY________  DATE OF BIRTH_________________________


RACE CHOICE: ______ 5 MILE RUN  ______2 MILE WALK


T-SHIRT SIZE: _____SM  _____ MED  _____LG  _____XL  _____XXL 

---$10.00 If postmarked by June 10, 1999 (non-refundable)

---$15.00 Race Day Registration

SPECIAL DIVISIONS: (Please check if eligible to compete in 
                    either of the following divisions.)

                  _______WHEELCHAIR DIVISION 
                  
                  _______MASTERS (40 YEARS OR OLDER)

• Checks & money orders are to be made payable to Kanawha Valley WVU Alumni Association.
• Send reigistration and payment to: Mountaineer Spirit Run, P.O. Box 11063, Charleston, WV 25339-1063

WAIVER AND RELEASE OF LIABILITY: Please carefully read the following waiver and release of liability, then provide your signature. For those younger than 18 years of age, a parent or legal guardian must provide his/her signature. MSR registration forms will not be processed if received without a signature and therefore applications will not be permitted to participate in the race.

In return for permission by the West Virginia University Alumni Association, its members, volunteers, corporate sponsors, media sponsors, business donors, and any other participants from any claim for injury or loss that occurs to me, my child, my ward or anyone else on whose behlf I am representing by my signature. In addition, I attest and verify that I am physically fit and have sufficiently trained for this event.

Waiver and release of liability:

___________________________________________________________ SIGNATURE (Parent or Guardian, if younger than 18 yrs old)