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Saturday, August 5, 2000 -- Benwood, WV
Debbie Green Memorial 5K Run & Walk

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Name________________________________________AGE_______

Address_______________________________________________

City_________________State___________Zip______________

Phone Number(_______)___________________________
Make check payable to: Debbie Green Memorial
Mail entry form to: Ronnie Green, Race Director, 506 McMechen Street, Benwood, WV 26031

For in and consideration of permission to participate in this race, I for myself, my executors, my heirs, administrative and assigns, waive and release all rights and claims I have against the sponsors, any financial participant, and their agents, for any injuries incurred by me during or in connection with this run.


Signature____________________________Date________________
(parent's signature if under 18)

Shirt Size - M     L     XL     XXL

Male___    Female___

Runner___  Walker___