Gene's Run For Special Olympics (MAGP #5)

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Sunday, August 5, 2001 -- Morgantown, WV
Gene's Run For Special Olympics (MAGP #5) (iPO Event Id#: 3176)

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Please make checks payable to: Monongalia County Special Olympics

Mail entry forms & fee to:
Gene's Run for Special Olympics
P.O. Box 41
Morgantown, WV 26505

For Additional Information Call: 304-292-4126

Grand Prix Entrant_____     Run_____      Fun Walk_____


NAME_______________________________SEX_______AGE_______


ADDRESS________________________________________________


CITY____________________________STATE______ZIP_________


TELEPHONE______________________________________________

(Please Circle One)
T-SHIRT SIZE:    L     XL    XXL

*Age as of August 5, 2001_______________

In return for permission by the Monongalia County Special Olympics to participate in Gene's 4 mile run or walk, I release the program, its members, volunteers, co-sponsors, and other participants from any claim for injury or loss that occurs to me or my child/ward or anyone on his or her behalf. I therefore attest and verify that I am physically fit and have sufficiently trained for this event.


____________________________________________________
SIGNATURE (PARENT OR GUARDIAN MUST SIGN IF UNDER 18)

Affiliates: WVMBA | MAGP | WVMTR | APRRS | WVCXS