Wednesday, July 4, 2001 -- Morgantown, WV
Spirit & Breath Challenge 10K (MAGP #3) (iPO Event Id#: 3175)

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Wednesday, July 4, 2001 -- Morgantown, WV
Spirit & Breath Challenge

NAME:____________________________________________________


ADDRESS:_________________________________________________


CITY:____________________________STATE:______ZIP:________


PHONE #:_________________________________________________


AGE AS OF 7/4/00_____________  MALE________FEMALE________

         In which event will you be participating?

    10K RUN_____ 5K RUN_____ 1 MILE RUN_____ 5K WALK_____

GRAND PRIX PARTICIPANT?   YES______  NO_______

T-SHIRT SIZE?  SMALL____ MED____ LG____ XL____ XXL____

___YES, I will be attending the La Pasta Festa, July 3, 2001.

___YES, I will be attending with_____guests. My guests will include____children six years of age or under. Enclosed, please find a check in the amount of $_________________.

___NO, I will be unable to attend the race or Pasta Festa, but would like to contribute to the research and treatment programs of the Comprehensive Lung Cancer Program at the Mary Babb Randolph Cancer Center. Please see that my check in the amount of $______________ made payable to the MBR Lung Cancer Education and Research Fund is forwarded to the Mary Babb Randolph Cancer Center.

RELEASE STATEMENT:
In consideration of acceptance of this entry, I waive any claims for all damages which may result from my participation, or from the participation of the minor that I am signing for in the 2001 Spirit & Breath Challenge. Any and all claims are waived for myself, heirs and assigns. The sponsors and their agents or representatives will assume no obligation for injuries or damages that may incur.

________________________________________________________________
SIGNATURE                                             Date

________________________________________________________________
SIGNATURE OF PARENT OR GUARDIAN    (If under 18)      Date
 
Team Application

All teams must be pre-registered and comprised of 5 members, with at
least one female member.

Team Name:________________________

Team Captain:_____________________

Address:__________________________
       
        __________________________

Phone:____________________________

Signature:________________________

Each team member must complete an individual application. All team
runners will be eligible for individual awards.

Runner 1:__________________________

Runner 2:__________________________

Runner 3:__________________________

Runner 4:__________________________

Runner 5:__________________________