Saturday, June 9, 2007 -- Charleston, WV
Run with a Cop 5K (iPO Event Id#: 10149)

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Please mail (and make checks payable) to: Run with a Cop
PO Box 2749, Charleston WV 25330, Attn: Cpl. John Frazier (304) 348-6470

NAME:___________________________________________

ADDRESS:________________________________________

CITY:_____________________________________________

STATE:_________________________ZIP:________________

PHONE#:__________________________________________

SEX:______AGE:_________

T-SHIRT SIZE: M_____ L_____ XL_____ XXL_____

PLEASE CHECK WHICH EVENT YOU ARE ENTERING:

5K RUN___($15) 5K WALK___($15)

WAIVER: In consideration of the acceptance of this entry, I waive all rights and claims for damage that I may have against the City of Charleston, Special Olympics, WV Law Enforcement, and all sponsors. I attest that I am physically fit and have trained for this event.

_____________________________________________________
Signature of Participant

_____________________________________________________
Signature of Parent or Legal Guardian (IF UNDER 18 YRS OF AGE)