Saturday, November 6, 1999 -- Wheeling
Paul T. Boos Memorial 5K+ Classic

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Paul T. Boos Memorial 5K+ Challenge Registraion Form

NAME:_________________________ AGE:_____ PHONE#____________

ADDRESS:___________________________________________________

CITY:_______________________________STATE:____ZIP:_________

PLEASE CHECK APPROPRIATE SPACE:

SHIRT SIZE:   Small____  Medium____  Large____  X-Large____     

Male ____  Female ____    

___Walker  ___OVHS&E Employee  ___Stratford Athletic Club Member

For and in consideration of permission to participate in this race, I for myself, my executors, administrator and assignees do hereby release and discharge the sponsors, contributors, officials, employees and all of the officers of the Ohio Valley Medical Center, Stratford Athletic Club, the Wheeling Park Commission and the Paul T. Boos Memorial 5K+ Challenge from all claims and damages arising from my participation in this race. I attest and verify that I am physically fit and sufficiently trained for this event.

SIGNATURE:__________________________________    DATE:__________
          (Parent's signature if under 18)