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Saturday, August 25, 2007 -- Saint Albans, WV / St. Albans Fire Department
Homeland Security 5K Run/3K Walk (iPO Event Id#: 10204)

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Please make check payable and mail to:
35th CST Family Readiness Group, 407 Rough Ridge Road, Hurricane, West Virginia 25526





T-shirt size: _____Small   ____Medium   _____Large   _____X Large   ___ X X Large

Age:__________  Gender:______ 5K Run_________    OR     3K Walk___________

Heavy Weight Division:  Yes / No   (males 200+ lbs. / females 160+ lbs.)
Member of the Military:   Yes    /     No

Please chose category you wish to participate in:  (only one category per
Age:  ________         Heavyweight:  ___________         Military: ____________

Waiver must be signed or entry will not be accepted: In consideration of my acceptance as a participant in the Homeland Security 5K Run / 3K Walk, I the undersigned, intending to be legally bound, hereby for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against any other individuals, entities or organizations assisting with the 5K Run / 3K Walk, and for any and all injuries suffered by me in this event. I attest and verify to the best of my knowledge, my physical condition and fitness are adequate for me to safely compete, and no physician or qualified individual has advised me against competing in the Homeland Security 5K Run / 3K Walk.
Signature: ____________________________________________________________ 

Date: ______________________
(parent or guardian must sign if runner is under age 18 years of age)