Sunday, August 5, 2007 -- Morgantown, WV / Gene's Place, South Park
Gene's Run For Special Olympics - MAGP Endurance #7
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Please make checks payable to: Monongalia County Special Olympics
Mail to: Gene's Run for Special Olympics, P.O. Box 41, Morgantown, WV 26505
Run ____ --- Grand Prix Entrant ____ --- Walk ____
NAME___________________________________________________
ADDRESS________________________________________________
CITY____________________________STATE______ZIP_________
PHONE__________________________________________________
(Please Circle One) T-SHIRT SIZE: L XL XXL
Male___ Female___ Birth Date_______________
*Age as of August 5, 2007_______________
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)